Provider Demographics
NPI:1376860791
Name:MINA, MARIAM MILAD (MD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:MILAD
Last Name:MINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-479-2665
Mailing Address - Fax:419-479-2639
Practice Address - Street 1:1000 REGENCY CT STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3074
Practice Address - Country:US
Practice Address - Phone:419-479-2665
Practice Address - Fax:419-479-2639
Is Sole Proprietor?:No
Enumeration Date:2010-04-24
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH35.120082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0087867Medicaid
OHH235720Medicare PIN