Provider Demographics
NPI:1164556387
Name:PHILIP MILLER MD PA
Entity Type:Organization
Organization Name:PHILIP MILLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-691-3993
Mailing Address - Street 1:3385 BURNS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4328
Mailing Address - Country:US
Mailing Address - Phone:561-691-3993
Mailing Address - Fax:561-691-3908
Practice Address - Street 1:3385 BURNS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4328
Practice Address - Country:US
Practice Address - Phone:561-691-3993
Practice Address - Fax:561-691-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34424261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC005OtherGROUP
FLAC005OtherGROUP
FLC08882Medicare UPIN
FL50893ZMedicare PIN