Healthcare Provider Details

I. General information

NPI: 1417059445
Provider Name (Legal Business Name): MILES MILLER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 HWY 93 S
EUREKA MT
59917
US

IV. Provider business mailing address

995 HWY 93 S
EUREKA MT
59917
US

V. Phone/Fax

Practice location:
  • Phone: 406-297-2438
  • Fax: 406-297-3374
Mailing address:
  • Phone: 406-297-2438
  • Fax: 406-297-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number71
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: