Healthcare Provider Details

I. General information

NPI: 1669477287
Provider Name (Legal Business Name): STEVEN E MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

IV. Provider business mailing address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-7953
  • Fax: 605-882-7954
Mailing address:
  • Phone: 605-882-7953
  • Fax: 605-882-7954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4878
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: