MEDICARE: BRETT MILLER

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	207ND0101X	MOHS-Micrographic Surgery Physician	MD461130	PA

General Provider Information

NPI Number	:	1376802884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT MILLER

Provider Business Mailing Address
First Line	:	2003 LOWER STATE RD BLDG 200
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-2622
Country	:	US
Telephone Number	:	215-345-6647
Fax Number	:	215-345-0460

Provider Business Practice Location Address
First Line	:	2003 LOWER STATE RD BLDG 200
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-2622
Country	:	US
Telephone Number	:	215-345-6647
Fax Number	:	215-345-0460

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

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	07/24/2019

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