Healthcare Provider Details

I. General information

NPI: 1891053922
Provider Name (Legal Business Name): STEPHEN A. MILLER,D.O.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W 8TH ST
COFFEYVILLE KS
67337-3101
US

IV. Provider business mailing address

1717 WEST 8TH
COFFEYVILLE KS
67337-3101
US

V. Phone/Fax

Practice location:
  • Phone: 620-251-0777
  • Fax: 620-251-4173
Mailing address:
  • Phone: 620-251-0777
  • Fax: 620-251-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number0521872
License Number StateKS

VIII. Authorized Official

Name: STEPHEN ALAN MILLER
Title or Position: OWNER
Credential: D.O.
Phone: 620-251-0777