Provider Demographics
NPI:1629126008
Name:MILLER, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1778 MORADA PL
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3325
Mailing Address - Country:US
Mailing Address - Phone:626-398-1498
Mailing Address - Fax:626-585-8705
Practice Address - Street 1:800 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3150
Practice Address - Country:US
Practice Address - Phone:626-585-8700
Practice Address - Fax:626-585-8705
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83261207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180030799OtherRAILROAD MEDICARE
CA00G832610Medicaid
CAG30218Medicare UPIN
CAWG83261AMedicare PIN