Clarence Harold Mielke, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

WAMD00025451 Issued in WA

Practice address

25415 E Mission Ave
Liberty Lake, WA 99019-9586

Phone

(509) 926-2600

Fax

(509) 891-2737

NPI assigned

Mar 10, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1299715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299715200000",
    "number": "1306144613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25415 E MISSION AVE",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990199586",
            "telephone_number": "509-926-2600",
            "fax_number": "509-891-2737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25415 E MISSION AVE",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990199586",
            "telephone_number": "509-926-2600",
            "fax_number": "509-891-2737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIELKE",
        "first_name": "CLARENCE",
        "middle_name": "HAROLD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-10",
        "last_updated": "2011-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "WAMD00025451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sully Moon, IP

• Specialist in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; 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.