Provider Demographics
NPI:1558758912
Name:MIAN, USMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:USMAN
Middle Name:
Last Name:MIAN
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 1:2104 W FIRST ST
Mailing Address - Street 2:#3103
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3224
Mailing Address - Country:US
Mailing Address - Phone:239-424-3513
Mailing Address - Fax:
Practice Address - Street 1:2104 W FIRST ST
Practice Address - Street 2:#3103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3224
Practice Address - Country:US
Practice Address - Phone:239-424-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL128350207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine