MEDICARE: SHAMAAL M 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	207L00000X	Anesthesiology Physician	ME122651	FL
2	207L00000X	Anesthesiology Physician	MD448084	PA
3	207L00000X	Anesthesiology Physician	25MA09360700	NJ

General Provider Information

NPI Number	:	1659514511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMAAL M MILLER M.D.

Provider Business Mailing Address
First Line	:	111 N 12TH ST
Second Line	:	APT. 1816
City	:	TAMPA
State	:	FL
Zip	:	33602-3661
Country	:	US
Telephone Number	:	912-257-6419
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N 12TH ST
Second Line	:	APT. 1816
City	:	TAMPA
State	:	FL
Zip	:	33602-3661
Country	:	US
Telephone Number	:	912-257-6419
Fax Number	:

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

Provider Enumeration Date	:	04/08/2009
Last Update Date	:	12/22/2016

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