Individual
CARY H MIELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3100 SAMFORD AVE, SHREVEPORT, LA 71103
(318) 226-3306
(318) 226-3319
Mailing address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0177
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
309011
LA
207X00000X
Orthopaedic Surgery Physician
32198
MN
207XP3100X
Pediatric Orthopaedic Surgery Physician
309011
LA
207XP3100X
Pediatric Orthopaedic Surgery Physician
32198
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2484931
—
LA
05
—
642085100
—
MN
Enumeration date
11/01/2006
Last updated
08/26/2024
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