Healthcare Provider Details

I. General information

NPI: 1518126218
Provider Name (Legal Business Name): LUKE MICHAEL MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 11/27/2023
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E COUNTY ROAD 540A
LAKELAND FL
33813-3825
US

IV. Provider business mailing address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3019
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7267
  • Fax: 866-264-8519
Mailing address:
  • Phone: 863-680-7000
  • Fax: 866-264-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number070481
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number070481
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number070481
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number070481
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME93288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: