Healthcare Provider Details

I. General information

NPI: 1104032911
Provider Name (Legal Business Name): LAWRENCE R MILLER MD A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 1018
BEVERLY HILLS CA
90211-3108
US

IV. Provider business mailing address

8500 WILSHIRE BLVD STE 1018
BEVERLY HILLS CA
90211-3108
US

V. Phone/Fax

Practice location:
  • Phone: 310-747-7246
  • Fax: 310-439-7246
Mailing address:
  • Phone: 310-747-7246
  • Fax: 310-439-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG59739
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG59739
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG59739
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG59739
License Number StateCA

VIII. Authorized Official

Name: LAWRENCE ROSS MILLER
Title or Position: PRESIDENT
Credential:
Phone: 310-747-7246