Healthcare Provider Details

I. General information

NPI: 1780611947
Provider Name (Legal Business Name): RACHEL J MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CHICAGO AVE CSC 390
MINNEAPOLIS MN
55404-4289
US

IV. Provider business mailing address

2530 CHICAGO AVE CSC 390
MINNEAPOLIS MN
55404-4289
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-5999
  • Fax: 612-813-6151
Mailing address:
  • Phone: 651-220-5999
  • Fax: 612-813-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number51407
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: