Provider Demographics
NPI:1316376510
Name:MILLER, KAPILA (CNIM)
Entity Type:Individual
Prefix:
First Name:KAPILA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:KAPILA
Other - Middle Name:
Other - Last Name:POTHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1604 VISA DR STE 1
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2195
Mailing Address - Country:US
Mailing Address - Phone:309-846-4716
Mailing Address - Fax:309-218-1415
Practice Address - Street 1:1604 VISA DR STE 1
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2195
Practice Address - Country:US
Practice Address - Phone:309-846-4716
Practice Address - Fax:309-218-1415
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic