Healthcare Provider Details

I. General information

NPI: 1427465483
Provider Name (Legal Business Name): JOHN WESLEY MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N PALM AVE STE 211
PEMBROKE PINES FL
33026-3204
US

IV. Provider business mailing address

1065 NE 125TH ST STE 300
NORTH MIAMI FL
33161-5833
US

V. Phone/Fax

Practice location:
  • Phone: 954-447-0010
  • Fax: 954-447-0899
Mailing address:
  • Phone: 888-852-6672
  • Fax: 786-235-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME169584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: