Provider Demographics
NPI:1336292861
Name:MILLER MEDICAL ASSOCIATES OF NEVADA, PC
Entity Type:Organization
Organization Name:MILLER MEDICAL ASSOCIATES OF NEVADA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-524-0367
Mailing Address - Street 1:2604B EL CAMINO REAL
Mailing Address - Street 2:#311
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1214
Mailing Address - Country:US
Mailing Address - Phone:702-524-0367
Mailing Address - Fax:760-943-8816
Practice Address - Street 1:2604B EL CAMINO REAL
Practice Address - Street 2:#311
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1214
Practice Address - Country:US
Practice Address - Phone:702-524-0367
Practice Address - Fax:760-943-8816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0999550001Medicare NSC