MEDICARE: DR. MICHAEL LEE MILLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	023433	LA
2	2086S0129X	Vascular Surgery Physician	ME98427	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154390730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL LEE MILLER M.D.

Provider Business Mailing Address
First Line	:	4607 CHANAN DRIVE
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539
Country	:	US
Telephone Number	:	850-682-2596
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 RACETRACK RD NE
Second Line	:	SUITE E4
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1882
Country	:	US
Telephone Number	:	850-200-4574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	01/09/2012

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