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General NPI Number Information
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NPI Number | 1154390730
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Entity Type | Individual
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Provider Name | MICHAEL LEE MILLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 11 RACETRACK RD NE SUITE E4
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1882
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Country | US
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Telephone | 850-200-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 CHANAN DRIVE
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City | CRESTVIEW
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State | FL
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Zip | 32539
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Country | US
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Telephone | 850-682-2596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 023433
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME98427
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License Number State | FL
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