Provider Demographics
NPI:1003897737
Name:MILLER, ADRIENE R (DO)
Entity Type:Individual
Prefix:DR
First Name:ADRIENE
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 S DIXIE HWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-4457
Mailing Address - Country:US
Mailing Address - Phone:561-568-1272
Mailing Address - Fax:561-345-3521
Practice Address - Street 1:400 S DIXIE HWY
Practice Address - Street 2:SUITE 12
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4457
Practice Address - Country:US
Practice Address - Phone:561-568-1272
Practice Address - Fax:561-345-3521
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017288207R00000X
FLOS10911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDM360ZMedicare PIN