Provider Demographics
NPI:1770787053
Name:MIAN, SOMIA (MD)
Entity type:Individual
Prefix:
First Name:SOMIA
Middle Name:
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 1:3330 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5250
Mailing Address - Country:US
Mailing Address - Phone:352-742-2192
Mailing Address - Fax:352-742-2689
Practice Address - Street 1:3330 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5250
Practice Address - Country:US
Practice Address - Phone:352-742-2192
Practice Address - Fax:352-742-2689
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57004902207R00000X
IA37979207R00000X, 207RG0100X, 207RI0008X
FLME146431207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113180900Medicaid
IAP00642661Medicare PIN