Provider Demographics
NPI:1619934387
Name:TRUMBLE, MILES W (MD PLLC)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:W
Last Name:TRUMBLE
Suffix:
Gender:M
Credentials:MD PLLC
Other - Prefix:
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Mailing Address - Street 1:1420 PLAZA DR
Mailing Address - Street 2:STE 1A
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-487-3937
Mailing Address - Fax:231-487-3939
Practice Address - Street 1:1420 PLAZA DR
Practice Address - Street 2:STE 1A
Practice Address - City:PETOKSEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-487-3937
Practice Address - Fax:231-487-3939
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMT030207207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI180034077OtherPALMETTOGBA
MI3481120Medicaid
P54436OtherBCN
180B410190OtherBLUE SHIELD
MI3481120Medicaid
MI0M76520001Medicare PIN