Provider Demographics
NPI:1144413568
Name:MILLER, STEPHANIE DANETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DANETTE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 S. MOUNT AUBURN, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CAPE GERARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703
Mailing Address - Country:US
Mailing Address - Phone:573-519-4500
Mailing Address - Fax:573-519-4530
Practice Address - Street 1:817 S. MOUNT AUBURN, SUITE 100
Practice Address - Street 2:SOUTHEAST PRIMARY CARE
Practice Address - City:CAPE GERARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703
Practice Address - Country:US
Practice Address - Phone:573-519-4500
Practice Address - Fax:573-519-4530
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL30060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine