Healthcare Provider Details

I. General information

NPI: 1720345085
Provider Name (Legal Business Name): MELINDA DOROTTYA MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

625 S NEW BALLAS RD STE 7020
SAINT LOUIS MO
63141-8218
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6486
  • Fax:
Mailing address:
  • Phone: 314-251-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036142356
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2015017280
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: