Healthcare Provider Details

I. General information

NPI: 1508427089
Provider Name (Legal Business Name): MATTHEW KINGSFORD MILLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13600 ICOT BLVD BLDG A
CLEARWATER FL
33760-3703
US

IV. Provider business mailing address

415 7TH AVE N
TIERRA VERDE FL
33715-1820
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-6900
  • Fax: 727-669-8417
Mailing address:
  • Phone: 727-512-8741
  • Fax: 727-669-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: