Brent W Miedema, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MDR7N00 Issued in MO

Practice address

800 Hospital Dr # 617
Columbia, MO 65201-5275

Phone

(573) 814-6346

NPI assigned

May 15, 2006

Last updated

Jul 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1033160734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 HOSPITAL DR # 617",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015275",
            "telephone_number": "573-814-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 HOSPITAL DR # 617",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015275",
            "telephone_number": "573-814-6346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIEDEMA",
        "first_name": "BRENT",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "MDR7N00",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203229802",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "20021458",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John William Middleton Jr., C.R.N.A.
• Julianne Midkiff, LCSW
• Midwest Anesthesia Alliance LLC
• Midwest Sinus Allergy Inc.
• Midwest Sinus Allergy Specialists, Inc
• Janet Miedema
• Julia Rose Miesner, AU.D
• Grace Mihal
• Margaret Elizabeth Mike, M.D.
• Mary Rasmy Azer Mikhael, MD

• Surgery Physician in Columbia, MO
• Providers in Columbia, MO by specialty
• Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.