Provider Demographics
NPI:1598794349
Name:MIELES, LUIS A (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name: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 1:6411 FANNIN ST
Mailing Address - Street 2:SUITE R7.21
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-704-6770
Mailing Address - Fax:713-704-7041
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:SUITE 370
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:713-704-6300
Practice Address - Fax:713-704-6360
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6118204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04623253OtherMISSISSIPPI MEDICAID
TX8W5621OtherBCBS
TXP00365834OtherRAIL ROAD MEDICARE
TX8J1278Medicare PIN
TX8W5621OtherBCBS