Provider Demographics
NPI:1508427089
Name:MILLER, MATTHEW KINGSFORD (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KINGSFORD
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:TIERRA VERDE
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1820
Mailing Address - Country:US
Mailing Address - Phone:727-512-8741
Mailing Address - Fax:727-669-8417
Practice Address - Street 1:13600 ICOT BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3703
Practice Address - Country:US
Practice Address - Phone:727-796-6900
Practice Address - Fax:727-669-8417
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4450213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program