Provider Demographics
NPI:1093886822
Name:MIELNICK, ALINA (MD)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:MIELNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BD HWY 71 N
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953
Mailing Address - Country:US
Mailing Address - Phone:479-394-1861
Mailing Address - Fax:479-394-1322
Practice Address - Street 1:601 BD HWY 71 N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953
Practice Address - Country:US
Practice Address - Phone:479-394-1861
Practice Address - Fax:479-394-1322
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4110208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04D0891056OtherAR LIC #R4110
AR118355001Medicaid
AR118355001Medicaid
AR54298Medicare ID - Type Unspecified
AR118355001Medicaid