Healthcare Provider Details

I. General information

NPI: 1124918214
Provider Name (Legal Business Name): EMILY MARIE MILLER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11223 AFTON RD
SOUTHGATE MI
48195-2801
US

IV. Provider business mailing address

11223 AFTON RD
SOUTHGATE MI
48195-2801
US

V. Phone/Fax

Practice location:
  • Phone: 734-837-1838
  • Fax:
Mailing address:
  • Phone: 734-837-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number4704299177
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: