Provider Demographics
NPI:1528386448
Name:LEE A MILLER MD APMC
Entity Type:Organization
Organization Name:LEE A MILLER MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-322-9882
Mailing Address - Street 1:312 GRAMMONT STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7403
Mailing Address - Country:US
Mailing Address - Phone:318-322-9882
Mailing Address - Fax:318-322-2006
Practice Address - Street 1:312 GRAMMONT STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7403
Practice Address - Country:US
Practice Address - Phone:318-322-9882
Practice Address - Fax:318-322-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD025050207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1421481Medicaid
LAH73202Medicare UPIN