Provider Demographics
NPI:1124413927
Name:MILLER, TIMOTHY JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3701 AVALON PARK WEST BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7303
Mailing Address - Country:US
Mailing Address - Phone:407-863-3655
Mailing Address - Fax:321-248-3763
Practice Address - Street 1:3701 AVALON PARK WEST BLVD STE 225
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7303
Practice Address - Country:US
Practice Address - Phone:407-863-3655
Practice Address - Fax:321-248-3763
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003862213ES0103X
FLPO4276213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery