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General NPI Number Information
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NPI Number | 1780238006
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Entity Type | Individual
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Provider Name | MILES SAUTEBEN PSC.D
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Gender | Male
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 604 N HIGH ST
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City | COLUMBIA
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State | TN
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Zip | 38401-3216
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Country | US
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Telephone | 615-219-9924
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Fax |
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Provider Business Mailing Address
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Address Line | 3085 COMMONWEALTH DR APT 1333
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City | SPRING HILL
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State | TN
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Zip | 37174-3127
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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 | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number | 4361311
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License Number State | TN
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