MEDICARE: MICHAEL D 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	2084P0800X	Psychiatry Physician	MD 039124-E	PA

General Provider Information

NPI Number	:	1497888473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D MILLER M.D.

Provider Business Mailing Address
First Line	:	255 S 17TH ST
Second Line	:	STE. 1410
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-545-8450
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST
Second Line	:	STE. 1410
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-545-8450
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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