Healthcare Provider Details

I. General information

NPI: 1144384868
Provider Name (Legal Business Name): VAN MILLER MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 COIT RD SUITE 150
PLANO TX
75075-5024
US

IV. Provider business mailing address

1708 COIT RD SUITE 150
PLANO TX
75075-5024
US

V. Phone/Fax

Practice location:
  • Phone: 972-769-9000
  • Fax: 972-769-0035
Mailing address:
  • Phone: 972-769-9000
  • Fax: 972-769-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberH2609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: