Healthcare Provider Details

I. General information

NPI: 1225072366
Provider Name (Legal Business Name): MICHAEL LEE MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS ALASKA (SSBN 732)
FPO AP
96698
US

IV. Provider business mailing address

1978 SNOWRIDGE AVE
PORT ORCHARD WA
98366-2045
US

V. Phone/Fax

Practice location:
  • Phone: 360-396-6090
  • Fax: 360-396-4247
Mailing address:
  • Phone: 360-731-8943
  • Fax: 360-396-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: