Healthcare Provider Details

I. General information

NPI: 1437169190
Provider Name (Legal Business Name): CELESTE MARIE MILLER-PARISH D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CELESTE M MILLER D.O

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SIGLER AVE STE A
MEMPHIS MO
63555-1726
US

IV. Provider business mailing address

450 E SIGLER AVE STE A
MEMPHIS MO
63555-1726
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-2828
  • Fax: 660-465-2820
Mailing address:
  • Phone: 660-465-2828
  • Fax: 660-465-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2002002085
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: