Provider Demographics
NPI:1104191063
Name:MILLER, CHRISTINE P (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:P
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 ICOT BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3703
Mailing Address - Country:US
Mailing Address - Phone:888-290-6321
Mailing Address - Fax:727-669-8417
Practice Address - Street 1:13600 ICOT BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3703
Practice Address - Country:US
Practice Address - Phone:888-290-6321
Practice Address - Fax:727-669-8417
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3678213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149383AMedicaid
FL012326400Medicaid
PA241402NSGOtherMEDICARE GROUP MEMBER PTAN
PA1027113900001Medicaid
FLHV834ZMedicare PIN