Provider Demographics
NPI:1558399659
Name:MILLER, GEORGI D (MD)
Entity Type:Individual
Prefix:
First Name:GEORGI
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-674-6797
Mailing Address - Fax:305-674-0784
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 490
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-674-6797
Practice Address - Fax:305-674-0784
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7688880OtherGHI
P00088997OtherRAILROAD MEDICARE
FLN205253OtherSTAYWELL HEALTH PLAN
FL039720OtherNHP
FL01928OtherBCBS
FL262053700Medicaid
FLN205253OtherWELLCARE
FL293054OtherAVMED
FLN205253OtherWELLCARE
FLH50038Medicare UPIN