Provider Demographics
NPI:1811977879
Name:MIAN, MUNIRA T (MD)
Entity type:Individual
Prefix:DR
First Name:MUNIRA
Middle Name:T
Last Name:MIAN
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 1:8105 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7806
Mailing Address - Country:US
Mailing Address - Phone:850-477-8080
Mailing Address - Fax:866-377-0742
Practice Address - Street 1:8105 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7806
Practice Address - Country:US
Practice Address - Phone:850-477-8080
Practice Address - Fax:866-377-0742
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61977208000000X
FLME61977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59167049OtherBLUE CROSS BLUE SHIELD AL
FL250912100Medicaid
FL370020497OtherRAILROAD MEDICARE
FLA057OtherHEALTH FIRST NETWORK
FL15177OtherBLUE CROSS BLUE SHIELD FL
AL59167049OtherBLUE CROSS BLUE SHIELD AL
FLF37520Medicare UPIN