Individual
DAVID T MIYAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2350 N LAKE DR, SUITE 406, MILWAUKEE, WI 53211-4528
(414) 271-4141
(414) 271-4343
Mailing address
4425 N PORT WASHINGTON RD, GLENDALE, WI 53212-1082
(414) 326-2218
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
33184
WI
207Y00000X
Otolaryngology Physician
4301051920
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090129
BCBSM PIN
MI
01
—
0400661
HELATHPLUS PROVIDER ID
MI
05
—
4172040
—
MI
Enumeration date
11/09/2005
Last updated
03/18/2016
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