Healthcare Provider Details

I. General information

NPI: 1831114974
Provider Name (Legal Business Name): STEVEN LYLE MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2571 MALIBU CT
COLTON CA
92324-9788
US

IV. Provider business mailing address

2571 MALIBU COURT
COLTON CA
92324
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-7966
  • Fax:
Mailing address:
  • Phone: 909-824-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00042389
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0061555
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberM3023
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD27109
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: