Organization
MIA MICHELLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA FROST MD (OWNER/PROVIDER)
(512) 785-6391
Entity
Organization
Contact information
Practice address
7115 GREENVILLE AVE, DALLAS, TX 75231-5100
(214) 647-5300
Mailing address
PO BOX 1889, MUNCIE, IN 47308-1889
(765) 284-0493
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
08/07/2024
Last updated
08/07/2024
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