Provider Demographics
NPI:1902126337
Name:MIRMIRAN, NEDA (DPM)
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:MIRMIRAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 CHAMPION GRANDVIEW WAY APT 26006
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8397
Mailing Address - Country:US
Mailing Address - Phone:512-705-5856
Mailing Address - Fax:737-358-9229
Practice Address - Street 1:6500 CHAMPION GRANDVIEW WAY APT 26006
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8397
Practice Address - Country:US
Practice Address - Phone:512-705-5856
Practice Address - Fax:737-358-9229
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2039213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist