Provider Demographics
NPI:1225072366
Name:MILLER, MICHAEL LEE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 SNOWRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2045
Mailing Address - Country:US
Mailing Address - Phone:360-731-8943
Mailing Address - Fax:360-396-4247
Practice Address - Street 1:USS ALASKA (SSBN 732)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96698
Practice Address - Country:US
Practice Address - Phone:360-396-6090
Practice Address - Fax:360-396-4247
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman