Provider Demographics
NPI:1437169190
Name:MILLER-PARISH, CELESTE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:MARIE
Last Name:MILLER-PARISH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CELESTE
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:450 E SIGLER AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MEMPHIS
Mailing Address - State:MO
Mailing Address - Zip Code:63555-1726
Mailing Address - Country:US
Mailing Address - Phone:660-465-2828
Mailing Address - Fax:660-465-2820
Practice Address - Street 1:450 E SIGLER AVE
Practice Address - Street 2:STE A
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-1726
Practice Address - Country:US
Practice Address - Phone:660-465-2828
Practice Address - Fax:660-465-2820
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002085208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245788807Medicaid
F21269Medicare UPIN
000095397Medicare ID - Type Unspecified