Basic Information
| Provider Information | |||||||||
| NPI: | 1588980973 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAIL | ||||||||
| FirstName: | MIJA | ||||||||
| MiddleName: | JENIQUE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3495 PIEDMONT ROAD NE | ||||||||
| Address2: | NINE PIEDMONT CENTER | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043650966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 TOWNPARK LANE | ||||||||
| Address2: | COMPREHENSIVE MEDICAL CENTER | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331402800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548169570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2010 | ||||||||
| LastUpdateDate: | 03/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 64290 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OS 10886 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.