Provider Demographics
NPI:1508894379
Name:MILLER, KURT V (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:V
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1660 E HERNDON AVE
Mailing Address - Street 2:150
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3359
Mailing Address - Country:US
Mailing Address - Phone:559-431-8500
Mailing Address - Fax:559-431-8520
Practice Address - Street 1:1660 E HERNDON AVE
Practice Address - Street 2:150
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3359
Practice Address - Country:US
Practice Address - Phone:559-431-8500
Practice Address - Fax:559-431-8520
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG5851402084N0400X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G585140Medicare ID - Type Unspecified
CAE89773Medicare UPIN