MEDICARE: DR. LAWRENCE ROSS MILLER M.D.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	G59739	CA

General Provider Information

NPI Number	:	1902879067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE ROSS MILLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 515110
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90051-5110
Country	:	US
Telephone Number	:	310-657-2202
Fax Number	:	310-289-9933

Provider Business Practice Location Address
First Line	:	8500 WILSHIRE BLVD
Second Line	:	STE 1018
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3108
Country	:	US
Telephone Number	:	310-747-7246
Fax Number	:	310-439-7246

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	05/09/2018

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