Provider Demographics
NPI:1477686368
Name:MILLER, STEPHEN MARC (MD, FACS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MARC
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4560 S EASTERN AVE
Mailing Address - Street 2:STE 18
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6182
Mailing Address - Country:US
Mailing Address - Phone:702-369-1001
Mailing Address - Fax:702-369-3030
Practice Address - Street 1:4560 S EASTERN AVE
Practice Address - Street 2:STE 18
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6182
Practice Address - Country:US
Practice Address - Phone:702-369-1001
Practice Address - Fax:702-369-3030
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist