Healthcare Provider Details

I. General information

NPI: 1912976770
Provider Name (Legal Business Name): MICHAEL LAWRENCE MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 E COTTON CENTER BLVD # CC10
PHOENIX AZ
85040-8893
US

IV. Provider business mailing address

PO BOX 840294
DALLAS TX
75284-0294
US

V. Phone/Fax

Practice location:
  • Phone: 602-648-8900
  • Fax:
Mailing address:
  • Phone: 888-344-1160
  • Fax: 972-331-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number43915
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number43915
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number005353
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: