Healthcare Provider Details

I. General information

NPI: 1225089162
Provider Name (Legal Business Name): LOIS A MILES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10359 CROSS CREEK BLVD
TAMPA FL
33647-2772
US

IV. Provider business mailing address

1124 W NASSAU ST
TAMPA FL
33607-5530
US

V. Phone/Fax

Practice location:
  • Phone: 813-994-0044
  • Fax: 813-994-0055
Mailing address:
  • Phone: 813-258-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number040962
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME66125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: