Healthcare Provider Details

I. General information

NPI: 1508968546
Provider Name (Legal Business Name): NOELLE E MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16611 S 40TH ST STE 160
PHOENIX AZ
85048
US

IV. Provider business mailing address

16611 S 40TH ST STE 160
PHOENIX AZ
85048
US

V. Phone/Fax

Practice location:
  • Phone: 480-940-8527
  • Fax: 480-940-8530
Mailing address:
  • Phone: 480-940-8527
  • Fax: 480-940-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33998
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: