Healthcare Provider Details

I. General information

NPI: 1104897404
Provider Name (Legal Business Name): LOLITA MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 INVERRARY BLVD
LAUDERHILL FL
33319-4104
US

IV. Provider business mailing address

800 SW 137TH AVE UNIT 212
PEMBROKE PINES FL
33027-3552
US

V. Phone/Fax

Practice location:
  • Phone: 954-748-2977
  • Fax:
Mailing address:
  • Phone: 954-436-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number179859
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME101266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: