Individual
DR. GREG M MIELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 LIGHTHOUSE LN, GOSHEN, IN 46526-3824
(574) 533-0348
(574) 533-0277
Mailing address
3926 NEW VISION DR, FORT WAYNE, IN 46845-1712
(260) 266-8210
(260) 458-5636
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01034860A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100113720
—
IN
Enumeration date
06/10/2006
Last updated
10/05/2016
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