Provider Demographics
NPI:1518072826
Name:CRAIG A. MILLER, DO, PA
Entity Type:Organization
Organization Name:CRAIG A. MILLER, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-852-3652
Mailing Address - Street 1:1400 HAND AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8194
Mailing Address - Country:US
Mailing Address - Phone:386-852-3652
Mailing Address - Fax:386-673-8009
Practice Address - Street 1:1400 HAND AVE
Practice Address - Street 2:SUITE K
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8194
Practice Address - Country:US
Practice Address - Phone:386-852-3652
Practice Address - Fax:386-673-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260025100Medicaid
FL260025100Medicaid
FLE3706Medicare PIN