Provider Demographics
NPI:1649412982
Name:MILES, MICHAEL GRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GRAHAM
Last Name:MILES
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 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:38 LAROSE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3452
Practice Address - Country:US
Practice Address - Phone:518-824-8181
Practice Address - Fax:833-819-0268
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268277207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03546343Medicaid
CO022560OtherKAISER COMMERCIAL NUMBER
CO022560OtherKAISER COMMERCIAL NUMBER