Provider Demographics
NPI:1275591745
Name:MILLER, MELISSA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6369 E TANQUE VERDE RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3850
Mailing Address - Country:US
Mailing Address - Phone:520-751-4124
Mailing Address - Fax:520-751-0337
Practice Address - Street 1:6369 E TANQUE VERDE RD
Practice Address - Street 2:SUITE 190
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3850
Practice Address - Country:US
Practice Address - Phone:520-751-4124
Practice Address - Fax:520-751-0337
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-05-15
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Provider Licenses
StateLicense IDTaxonomies
AZ20118208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ078487Medicaid
AZ078487Medicaid