Individual
ROBERT H MIELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
209 S MAIN ST, POPLAR BLUFF, MO 63901-5831
(573) 686-5550
(573) 686-2139
Mailing address
209 S MAIN ST, POPLAR BLUFF, MO 63901-5831
(573) 686-5550
(573) 686-2139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
063979
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184883
IND BCBS
MO
05
—
912876216
—
MO
01
—
P00165165
RAILROAD MEDICARE
MO
Enumeration date
01/09/2006
Last updated
02/27/2012
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