Healthcare Provider Details

I. General information

NPI: 1992701213
Provider Name (Legal Business Name): KRISTIN A MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S CODY RD
LE CLAIRE IA
52753-9579
US

IV. Provider business mailing address

200 S CODY RD
LE CLAIRE IA
52753-9579
US

V. Phone/Fax

Practice location:
  • Phone: 563-289-2273
  • Fax: 563-289-1605
Mailing address:
  • Phone: 563-289-2273
  • Fax: 563-289-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34144
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: