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NPI Code Detail

MEDICARE: DR. THOMAS E MILLER M.D.

MEDICARE: DR. THOMAS E 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
1174400000XSpecialist25196MN

Other Identifiers

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

General Provider Information

NPI Number : 1639175730
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS E MILLER M.D.
Provider Business Mailing Address
First Line : 3807 GREENLEAF AVE NW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-5817
Country : US
Telephone Number : 218-781-9746
Fax Number : 218-759-0620
Provider Business Practice Location Address
First Line : 3807 GREENLEAF AVE NW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-5817
Country : US
Telephone Number : 218-781-9746
Fax Number : 218-759-0620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 04/20/2011

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