Healthcare Provider Details

I. General information

NPI: 1407990161
Provider Name (Legal Business Name): ARLO J MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NW GILMAN BLVD SUITE 301A
ISSAQUAH WA
98027-2483
US

IV. Provider business mailing address

450 NW GILMAN BLVD SUITE 301A
ISSAQUAH WA
98027-2483
US

V. Phone/Fax

Practice location:
  • Phone: 425-654-1275
  • Fax: 425-654-0539
Mailing address:
  • Phone: 425-654-1275
  • Fax: 425-654-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD60173899
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD60173899
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD60173899
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD60173899
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: