Healthcare Provider Details

I. General information

NPI: 1780648030
Provider Name (Legal Business Name): LEE ANTHONY MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 KILPATRICK BLVD
MONROE LA
71201-5139
US

IV. Provider business mailing address

604 N ACADIA RD STE 101
THIBODAUX LA
70301-4897
US

V. Phone/Fax

Practice location:
  • Phone: 318-855-6282
  • Fax: 318-855-6424
Mailing address:
  • Phone: 985-446-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number025050
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number025050
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: