Provider Demographics
NPI:1831381573
Name:PODIATRY SPECIALISTS OF RI
Entity type:Organization
Organization Name:PODIATRY SPECIALISTS OF RI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIELE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-751-4701
Mailing Address - Street 1:1539 ATWOOD AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919
Mailing Address - Country:US
Mailing Address - Phone:401-751-4701
Mailing Address - Fax:401-454-4451
Practice Address - Street 1:1539 ATWOOD AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919
Practice Address - Country:US
Practice Address - Phone:401-751-4701
Practice Address - Fax:401-454-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00242213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007054Medicaid
RI70544OtherBCBS RI
RI202117OtherBLUE CHIP
RI9007054Medicaid
RIT79192Medicare UPIN