Provider Demographics
NPI:1912932559
Name:BEHERA, MILLIE ALIVA (MD)
Entity type:Individual
Prefix:MRS
First Name:MILLIE
Middle Name:ALIVA
Last Name:BEHERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8415 N PIMA RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4480
Mailing Address - Country:US
Mailing Address - Phone:480-434-6565
Mailing Address - Fax:480-434-6572
Practice Address - Street 1:8415 N PIMA RD
Practice Address - Street 2:SUITE 290
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4480
Practice Address - Country:US
Practice Address - Phone:480-434-6565
Practice Address - Fax:480-434-6572
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-01023207V00000X
AZ42873207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2035743AMedicare PIN
NC2035743BMedicare PIN
I22795Medicare UPIN