Provider Demographics
NPI:1033121306
Name:LOREN J MILLER DPM PLC
Entity Type:Organization
Organization Name:LOREN J MILLER DPM PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-544-5425
Mailing Address - Street 1:5415 PARK ST N
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1087
Mailing Address - Country:US
Mailing Address - Phone:727-544-5425
Mailing Address - Fax:727-544-5440
Practice Address - Street 1:5415 PARK ST N
Practice Address - Street 2:SUITE C
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1087
Practice Address - Country:US
Practice Address - Phone:727-544-5425
Practice Address - Fax:727-544-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1707332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55616Medicare UPIN
FL87948Medicare ID - Type UnspecifiedPROVIDER
FL1193010002Medicare NSC