MEDICARE: RENAE THERESE MILLER HLPC COSM

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	335E00000X	Prosthetic/Orthotic Supplier		OH
2	224900000X	Mastectomy Fitter

General Provider Information

NPI Number	:	1578151874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAE THERESE MILLER HLPC COSM

Provider Business Mailing Address
First Line	:	6555 WILSON MILLS RD STE 105
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44143-3435
Country	:	US
Telephone Number	:	440-213-1426
Fax Number	:

Provider Business Practice Location Address
First Line	:	6555 WILSON MILLS RD STE 105
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44143-3435
Country	:	US
Telephone Number	:	440-461-4247
Fax Number	:

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

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	02/08/2022

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