Healthcare Provider Details

I. General information

NPI: 1942569215
Provider Name (Legal Business Name): STEPHEN DANIEL MILLER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 350
SAINT LOUIS MO
63141-8669
US

IV. Provider business mailing address

PO BOX 14369
SAINT LOUIS MO
63178-4369
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-6071
  • Fax: 314-453-9965
Mailing address:
  • Phone: 314-567-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2012012818
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: