Provider Demographics
NPI:1477619336
Name:MILLER, PHILIP LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LAURENCE
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NE 12TH AVE
Mailing Address - Street 2:APT. 308
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4514
Mailing Address - Country:US
Mailing Address - Phone:954-456-5267
Mailing Address - Fax:
Practice Address - Street 1:400 NE 12TH AVE
Practice Address - Street 2:APT. 308
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4510
Practice Address - Country:US
Practice Address - Phone:954-456-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0035883208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93862Medicare ID - Type Unspecified
FLD64631Medicare UPIN