Provider Demographics
NPI:1225089162
Name:MILES, LOIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:A
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1124 W NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5530
Mailing Address - Country:US
Mailing Address - Phone:813-258-4775
Mailing Address - Fax:
Practice Address - Street 1:10359 CROSS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2772
Practice Address - Country:US
Practice Address - Phone:813-994-0044
Practice Address - Fax:813-994-0055
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040962208000000X
FLME66125208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000677223Medicaid