MEDICARE: HART LEGRAND MILLER MD

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	207Q00000X	Family Medicine Physician	0101232571	VA
2	207QA0505X	Adult Medicine Physician	14141	HI

General Provider Information

NPI Number	:	1831109933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HART LEGRAND MILLER MD

Provider Business Mailing Address
First Line	:	15-2662 PAHOA VILLAGE RD
Second Line	:	SUITE 306 PMB 8741
City	:	PAHOA
State	:	HI
Zip	:	96778-7730
Country	:	US
Telephone Number	:	808-930-6001
Fax Number	:	808-930-6007

Provider Business Practice Location Address
First Line	:	15-2662 PAHOA VILLAGE RD
Second Line	:	SUITE 306 PMB 8741
City	:	PAHOA
State	:	HI
Zip	:	96778-7730
Country	:	US
Telephone Number	:	808-930-6001
Fax Number	:	808-930-6007

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2015

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Directions to “ HART LEGRAND MILLER MD” Practice Location

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