Provider Demographics
NPI:1679508006
Name:MIELKE, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:MIELKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2845 HAMLINE AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-631-6410
Mailing Address - Fax:651-631-6343
Practice Address - Street 1:2845 HAMLINE AVE NORTH
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-631-6410
Practice Address - Fax:651-631-6343
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN25460207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D81575Medicare UPIN