Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 32198 | MN |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 309011 | LA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 32198 | MN |
NPI | 1568549574 |
---|---|
Provider Name | Cary H Mielke |
First Address | Philadelphia, PA 19178-7642 |
Second Address | Shreveport, LA 71103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 16/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2484931 | (05) | LA |
642085100 | (05) | MN |
F63538 | (02) | MN |