Healthcare Provider Details

I. General information

NPI: 1144221292
Provider Name (Legal Business Name): AMY L. MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 JEFFERSON HWY
NEW ORLEANS LA
70121-2406
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3900
  • Fax: 504-842-0011
Mailing address:
  • Phone: 504-207-3060
  • Fax: 504-207-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number10642R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.10642R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: