Provider Demographics
NPI:1275514754
Name:MILLER, LISA F (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:F
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 MADISON ST
Mailing Address - Street 2:STE 1440
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3538
Mailing Address - Country:US
Mailing Address - Phone:206-625-0578
Mailing Address - Fax:206-625-9184
Practice Address - Street 1:16251 SYLVESTER RD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3017
Practice Address - Country:US
Practice Address - Phone:206-244-1212
Practice Address - Fax:206-244-1223
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042548207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4672MIOtherREGENCE BLUE SHIELD
WA8931738OtherCRIME VICTIMS PGM
WA0172744OtherDEPT OF LABOR & INDUSTRIE
WA8366189Medicaid
P00051771Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AB38503Medicare ID - Type Unspecified
WA8366189Medicaid