Basic Information
| Provider Information | |||||||||
| NPI: | 1346418829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WANDRA K. MILES, MD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50150 | ||||||||
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| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980150150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252285228 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3137 TONGASS AVE | ||||||||
| Address2: | |||||||||
| City: | KETCHIKAN | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999015745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062926226 | ||||||||
| FaxNumber: | 2066238825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2008 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | MILES | ||||||||
| AuthorizedOfficialFirstName: | WANDRA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2062926226 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 4971 | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.