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NPI Code Detail

MEDICARE: MILLER J VAN VLIET DO

MEDICARE: MILLER J VAN VLIET DO
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
1207L00000XAnesthesiology Physician200401590NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
22035752BOTHERNCMEDICARE PTAN
32035752DOTHERNCMEDICARE PTAN

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 : 1891790622
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILLER J VAN VLIET DO
Provider Business Mailing Address
First Line : 200 PROVIDENCE RD
Second Line : ST. 101
City : CHARLOTTE
State : NC
Zip : 28207-1468
Country : US
Telephone Number : 704-749-5800
Fax Number : 704-749-5819
Provider Business Practice Location Address
First Line : 240 HOSPITAL DR NE
Second Line :
City : BOLIVIA
State : NC
Zip : 28422-8346
Country : US
Telephone Number : 704-749-5800
Fax Number : 704-749-5819
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 07/11/2012

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Directions to “ MILLER J VAN VLIET DO” Practice Location

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