Healthcare Provider Details

I. General information

NPI: 1386980753
Provider Name (Legal Business Name): MR. MICHAEL REED MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 RESEARCH BLVD STE 100-C
AUSTIN TX
78759-5722
US

IV. Provider business mailing address

10900 RESEARCH BLVD STE 100-C
AUSTIN TX
78759-5722
US

V. Phone/Fax

Practice location:
  • Phone: 512-487-5665
  • Fax: 512-494-4683
Mailing address:
  • Phone: 512-487-5665
  • Fax: 512-494-4683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number11149
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: