Provider Demographics
NPI:1114779113
Name:MEDINA MIELES, MAURICIO ANDRES (MD)
Entity Type:Individual
Prefix:MR
First Name:MAURICIO
Middle Name:ANDRES
Last Name:MEDINA MIELES
Suffix:
Gender:M
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:CARRERA 85D#48-56
Mailing Address - Street 2:COLORES DE SANTA SOFIA TORRE 5 APARTAMENTO 420
Mailing Address - City:CALI
Mailing Address - State:VALLE DEL CAUCA
Mailing Address - Zip Code:76001
Mailing Address - Country:CO
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 MEMORIAL DRIVE HAMILTON MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720
Practice Address - Country:US
Practice Address - Phone:706-226-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program