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General NPI Number Information
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NPI Number | 1356861330
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Entity Type | Individual
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Provider Name | MINDY KIM-MILLER MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/21/2017
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Provider Practice Location Address
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Address Line | 905 WILLOW DR
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City | JACKSON
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State | WY
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Zip | 83001-9353
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Country | US
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Telephone | 130-773-4299
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Fax |
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Provider Business Mailing Address
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Address Line | 905 WILLOW DR
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City | JACKSON
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State | WY
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Zip | 83001-9353
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Country | US
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Telephone |
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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 | 207UN0902X
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Taxonomy Name | Nuclear Imaging & Therapy Physician
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License Number | 036119528
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License Number State | IL
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