MEDICARE: STEPHANIE MILLER D.O.

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	208000000X	Pediatrics Physician	S7284	TX
2	2081P0010X	Pediatric Rehabilitation Medicine Physician	S7284	TX

General Provider Information

NPI Number	:	1447663562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MILLER D.O.

Provider Business Mailing Address
First Line	:	6701 FANNIN ST STE D1280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2608
Country	:	US
Telephone Number	:	832-826-6106
Fax Number	:	832-825-8978

Provider Business Practice Location Address
First Line	:	6701 FANNIN ST STE 1280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2613
Country	:	US
Telephone Number	:	832-826-6106
Fax Number	:	328-258-8978

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

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	11/06/2020

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