MEDICARE: MILLER MEDICAL ASSOCIATES OF NEVADA, PC

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1336292861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER MEDICAL ASSOCIATES OF NEVADA, PC

Provider Business Mailing Address
First Line	:	2604B EL CAMINO REAL
Second Line	:	#311
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1214
Country	:	US
Telephone Number	:	702-524-0367
Fax Number	:	760-943-8816

Provider Business Practice Location Address
First Line	:	2604B EL CAMINO REAL
Second Line	:	#311
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1214
Country	:	US
Telephone Number	:	702-524-0367
Fax Number	:	760-943-8816

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK STEVE MILLER
Credential	:	D.P.M.
Telephone Number	:	702-524-0367

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	12/18/2007

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