Provider Demographics
NPI:1164465886
Name:MIAO, PETER VW (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:VW
Last Name:MIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:MIAO MD INC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5000 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1793
Mailing Address - Country:US
Mailing Address - Phone:818-784-5300
Mailing Address - Fax:818-784-5301
Practice Address - Street 1:5000 VAN NUYS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1793
Practice Address - Country:US
Practice Address - Phone:818-784-5300
Practice Address - Fax:818-784-5301
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28541207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G285410Medicaid
CA00G285410Medicaid
CAG28541Medicare ID - Type Unspecified