MEDICARE: LAURA MARTIN 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	207R00000X	Internal Medicine Physician	80037	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ89670Z	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1487608774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARTIN MILLER M.D.

Provider Business Mailing Address
First Line	:	3260 SACRAMENTO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2739
Country	:	US
Telephone Number	:	510-601-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	10700 MACARTHUR BLVD
Second Line	:	SUITE 14B
City	:	OAKLAND
State	:	CA
Zip	:	94605-5298
Country	:	US
Telephone Number	:	510-563-4300
Fax Number	:

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/05/2012

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