Healthcare Provider Details

I. General information

NPI: 1013476464
Provider Name (Legal Business Name): MIRIAM V MILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 E 21ST ST
TULSA OK
74114-1958
US

IV. Provider business mailing address

710 S PHOENIX AVE
TULSA OK
74127-8835
US

V. Phone/Fax

Practice location:
  • Phone: 918-439-4434
  • Fax:
Mailing address:
  • Phone: 918-382-9085
  • Fax: 918-382-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MIRIAM V MILLS
Title or Position: OWNER/OPERATOR
Credential: M.D.
Phone: 183-829-0859