Healthcare Provider Details

I. General information

NPI: 1639257090
Provider Name (Legal Business Name): ELIZABETH ANNE MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 NE 116TH AVE SUITE 620
BELLEVUE WA
98004
US

IV. Provider business mailing address

1135 NE 116TH AVE SUITE 620
BELLEVUE WA
98004
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-8016
  • Fax: 425-453-2827
Mailing address:
  • Phone: 425-454-8016
  • Fax: 425-453-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD00040391
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: