Provider Demographics
NPI:1225066707
Name:MILLER, KATHERINE E (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-5000
Mailing Address - Fax:208-302-5025
Practice Address - Street 1:2141 E PARK CENTER BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6701
Practice Address - Country:US
Practice Address - Phone:208-302-5000
Practice Address - Fax:208-302-5025
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM8922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806358200Medicaid
I43708Medicare UPIN