Healthcare Provider Details

I. General information

NPI: 1982104899
Provider Name (Legal Business Name): MILLER EMERGENCY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90290 OVERSEAS HWY STE 105
TAVERNIER FL
33070-2263
US

IV. Provider business mailing address

90290 OVERSEAS HWY STE 105
TAVERNIER FL
33070-2263
US

V. Phone/Fax

Practice location:
  • Phone: 305-453-6097
  • Fax: 305-735-4014
Mailing address:
  • Phone: 305-453-6097
  • Fax: 305-735-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: WENDI S MILLER
Title or Position: PRINCIPAL
Credential: MD
Phone: 586-850-5351