MEDICARE: AMY MILLER PA

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	363A00000X	Physician Assistant	20623	CA

General Provider Information

NPI Number	:	1669425427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MILLER PA

Provider Business Mailing Address
First Line	:	330 DAVID DR
Second Line	:
City	:	ALAMO
State	:	CA
Zip	:	94507-1308
Country	:	US
Telephone Number	:	773-848-1796
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 DAVID DR
Second Line	:
City	:	ALAMO
State	:	CA
Zip	:	94507-1308
Country	:	US
Telephone Number	:	773-848-1796
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	02/11/2022

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