Provider Demographics
NPI:1265490718
Name:MILLER, MARK PAGE (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PAGE
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 POPLAR AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3957
Mailing Address - Country:US
Mailing Address - Phone:901-753-6163
Mailing Address - Fax:901-753-6159
Practice Address - Street 1:7655 POPLAR AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3957
Practice Address - Country:US
Practice Address - Phone:901-753-6163
Practice Address - Fax:901-753-6159
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15293208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4346314OtherBCBS
TNP01240990OtherRAILROAD MEDICARE
TN4346314OtherBCBS
TNA97493Medicare UPIN