Healthcare Provider Details

I. General information

NPI: 1518462720
Provider Name (Legal Business Name): ANDREW MICHAEL MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2846 SW 87TH WAY STE A
GAINESVILLE FL
32608-9341
US

IV. Provider business mailing address

PO BOX 100237
GAINESVILLE FL
32610-3001
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0944
  • Fax: 352-594-8511
Mailing address:
  • Phone: 352-265-1234
  • Fax: 352-265-9584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME149357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: