Provider Demographics
NPI:1477024065
Name:MILES, HANNIBAL (ND, MS, CNS)
Entity Type:Individual
Prefix:DR
First Name:HANNIBAL
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:ND, MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HIGH RIDGE RD FL 1
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3813
Mailing Address - Country:US
Mailing Address - Phone:203-529-5443
Mailing Address - Fax:203-614-1391
Practice Address - Street 1:111 HIGH RIDGE RD FL 1
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3813
Practice Address - Country:US
Practice Address - Phone:203-529-5443
Practice Address - Fax:203-612-1491
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-08
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT634175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath