Provider Demographics
NPI:1265501340
Name:MIELE, JOHN R (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:MIELE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 ATWOOD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919
Mailing Address - Country:US
Mailing Address - Phone:401-751-4701
Mailing Address - Fax:401-454-4451
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919
Practice Address - Country:US
Practice Address - Phone:401-751-4701
Practice Address - Fax:401-454-4451
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00242213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI202117OtherBLUE CHIP
RI9007054Medicaid
RI70544OtherBLUE CROSS RI
RI202117OtherBLUE CHIP
RI489007054Medicare ID - Type Unspecified
RI9007054Medicaid
T79192Medicare UPIN