MEDICARE: DR. ALLEN DAVID MILLER M.D., M.B.A

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	174400000X	Specialist	ME34422	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4129479	OTHER	FL	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1851399497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN DAVID MILLER M.D., M.B.A

Provider Business Mailing Address
First Line	:	3006 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3139
Country	:	US
Telephone Number	:	813-874-3006
Fax Number	:	813-876-6258

Provider Business Practice Location Address
First Line	:	3006 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3139
Country	:	US
Telephone Number	:	813-874-3006
Fax Number	:	813-876-6258

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/01/2010

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