Healthcare Provider Details

I. General information

NPI: 1902906373
Provider Name (Legal Business Name): GLENDESE CAMILLE MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 NORTH FLAGLER DRIVE
WEST PALM BEACH FL
33401
US

IV. Provider business mailing address

1309 NORTH FLAGLER DRIVE
WEST PALM BEACH FL
33401
US

V. Phone/Fax

Practice location:
  • Phone: 561-882-4541
  • Fax: 561-650-6093
Mailing address:
  • Phone: 561-882-4541
  • Fax: 561-650-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME104698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: