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General NPI Number Information
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NPI Number | 1598758351
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Entity Type | Individual
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Provider Name | MARC L MILLER MD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 3801 SANTA ROSA DR STE 301
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City | KINGMAN
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State | AZ
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Zip | 86401-2311
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Country | US
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Telephone | 928-681-8730
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Fax | 928-681-8731
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Provider Business Mailing Address
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Address Line | 51 SEWALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-2643
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Country | US
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Telephone | 207-774-5761
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Fax | 207-874-7478
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD11083
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 59883
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License Number State | AZ
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