Provider Demographics
NPI:1518005271
Name:MILLER, DIANE RANKIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:RANKIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:RANKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:889 S BRENTWOOD BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2562
Mailing Address - Country:US
Mailing Address - Phone:314-721-4688
Mailing Address - Fax:314-726-4028
Practice Address - Street 1:889 S BRENTWOOD BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2562
Practice Address - Country:US
Practice Address - Phone:314-721-4688
Practice Address - Fax:314-726-4028
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOR40172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E45628Medicare UPIN