Provider Demographics
NPI:1609028356
Name:MILLER, THERESA B (PA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:B
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1555 SOUTH BLVD E STE 390
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5624
Practice Address - Country:US
Practice Address - Phone:248-267-5790
Practice Address - Fax:248-267-5799
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant