Provider Demographics
NPI:1265273346
Name:NEDA MIRMIRAN DPM
Entity type:Organization
Organization Name:NEDA MIRMIRAN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRMIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-705-5856
Mailing Address - Street 1:6500 CHAMPION GRANDVIEW WAY APT 26006
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 CHAMPION GRANDVIEW WAY APT 26006
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8397
Practice Address - Country:US
Practice Address - Phone:512-705-5856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric