Provider Demographics
NPI:1912265968
Name:MILAD, MENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MENA
Middle Name:
Last Name:MILAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2108
Mailing Address - Country:US
Mailing Address - Phone:903-558-2222
Mailing Address - Fax:903-558-2225
Practice Address - Street 1:1216 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2108
Practice Address - Country:US
Practice Address - Phone:903-558-2222
Practice Address - Fax:903-558-2225
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3053207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX389678901Medicaid
TX8JX850OtherBCBS
TXP02098053OtherMEDICARE RAIL ROAD
TX705000OtherMEDICARE