Provider Demographics
NPI:1689628257
Name:MIKLIUS, AUDREY BETTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:BETTINA
Last Name:MIKLIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10260 N CENTRAL EXPY STE 100N
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3437
Mailing Address - Country:US
Mailing Address - Phone:214-363-5535
Mailing Address - Fax:214-368-2760
Practice Address - Street 1:10260 N CENTRAL EXPY STE 100N
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3437
Practice Address - Country:US
Practice Address - Phone:214-363-5535
Practice Address - Fax:214-368-2760
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1877207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84680JOtherBCBS
TX4415210OtherAETNA
TXPO84680JMedicaid
TX84680JMedicare PIN
TXMF71051Medicare UPIN