Healthcare Provider Details

I. General information

NPI: 1104191063
Provider Name (Legal Business Name): CHRISTINE P MILLER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13600 ICOT BLVD BLDG B
CLEARWATER FL
33760-3703
US

IV. Provider business mailing address

13600 ICOT BLVD BLDG B
CLEARWATER FL
33760-3703
US

V. Phone/Fax

Practice location:
  • Phone: 888-290-6321
  • Fax: 727-669-8417
Mailing address:
  • Phone: 888-290-6321
  • Fax: 727-669-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: