Provider Demographics
NPI:1568235372
Name:MILLER, TONY ELLIOT
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:ELLIOT
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MINNEAPOLIS VA HEALTH CARE SYSTEM 1 VETERANS DRIVE
Mailing Address - Street 2:MAIL # 116-A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417
Mailing Address - Country:US
Mailing Address - Phone:612-725-2000
Mailing Address - Fax:
Practice Address - Street 1:MINNEAPOLIS VA HEALTH CARE SYSTEM 1 VETERANS DRIVE
Practice Address - Street 2:MAIL # 116-A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417
Practice Address - Country:US
Practice Address - Phone:612-725-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN323131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical