MEDICARE: DENNIS MILLER II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1316327588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS MILLER II

Provider Business Mailing Address
First Line	:	PO BOX 24599
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76124-1599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6731 BRIDGE ST # 213
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-0817
Country	:	US
Telephone Number	:	817-917-5696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	06/03/2015

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