Provider Demographics
NPI:1376631689
Name:MIAN, NOSHEEN AMIR (MD)
Entity type:Individual
Prefix:
First Name:NOSHEEN
Middle Name:AMIR
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 1:5625 EIGER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8982
Mailing Address - Country:US
Mailing Address - Phone:512-892-7076
Mailing Address - Fax:855-270-9668
Practice Address - Street 1:5625 EIGER RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8982
Practice Address - Country:US
Practice Address - Phone:512-892-7076
Practice Address - Fax:855-270-9668
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90004207Q00000X
TXV3643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR07110012300OtherQUALCHOICE
AR163962001Medicaid
GA90004OtherLICENSE
AR785873OtherHEALTHLINK
AR7940907OtherAETNA
GA90004OtherLICENSE
ARI71867Medicare UPIN