Provider Demographics
NPI:1619108719
Name:MIEGGE VIERA, MARIA LAURA (M D)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LAURA
Last Name:MIEGGE VIERA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:24 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3905
Mailing Address - Country:US
Mailing Address - Phone:515-574-6890
Mailing Address - Fax:515-574-6458
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:SUITE G
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-574-6865
Practice Address - Fax:515-576-5880
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA38399208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery