Provider Demographics
NPI:1346228830
Name:MILLER, SHADI I (MD)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:I
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:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-687-4900
Mailing Address - Fax:541-687-4904
Practice Address - Street 1:330 S GARDEN WAY
Practice Address - Street 2:STE 350
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8176
Practice Address - Country:US
Practice Address - Phone:541-746-6816
Practice Address - Fax:541-726-3177
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25016207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022714Medicaid
OR022714Medicaid
ORR135847Medicare PIN