Healthcare Provider Details

I. General information

NPI: 1174941140
Provider Name (Legal Business Name): LAURA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/25/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17345 CIVIC DR STE 1327
BROOKFIELD WI
53045
US

IV. Provider business mailing address

PO BOX 1327
BROOKFIELD WI
53008-1327
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-7330
  • Fax:
Mailing address:
  • Phone: 414-447-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number75376-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number75376-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: