Healthcare Provider Details

I. General information

NPI: 1811986201
Provider Name (Legal Business Name): KARIN L MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARIN L WOLFORD MD

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 11/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVENUE K SE STE 6
WINTER HAVEN FL
33880-4123
US

IV. Provider business mailing address

400 AVENUE K SE STE 6
WINTER HAVEN FL
33880-4123
US

V. Phone/Fax

Practice location:
  • Phone: 863-229-4567
  • Fax: 863-297-9750
Mailing address:
  • Phone: 863-299-4567
  • Fax: 863-297-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43996
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35487
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: