Provider Demographics
NPI:1255335287
Name:MILES, MARK G (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:MILES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:820 W DANFORTH RD
Mailing Address - Street 2:# 133
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5006
Mailing Address - Country:US
Mailing Address - Phone:405-367-7625
Mailing Address - Fax:
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:STE 580
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4420
Practice Address - Country:US
Practice Address - Phone:405-917-3518
Practice Address - Fax:405-951-4361
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2017-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK18554207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243501403Medicare PIN