Healthcare Provider Details

I. General information

NPI: 1528386448
Provider Name (Legal Business Name): LEE A MILLER MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 GRAMMONT STREET SUITE 303
MONROE LA
71201-7403
US

IV. Provider business mailing address

312 GRAMMONT STREET SUITE 303
MONROE LA
71201-7403
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-9882
  • Fax: 318-322-2006
Mailing address:
  • Phone: 318-322-9882
  • Fax: 318-322-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD025050
License Number StateLA

VIII. Authorized Official

Name: LEE A MILLER
Title or Position: OWNER
Credential: M.D.
Phone: 318-322-9882