Provider Demographics
NPI:1689878019
Name:MILLER, HARVEY WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:WALTER
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 1:119 VOYAGE MALL
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7296
Mailing Address - Country:US
Mailing Address - Phone:310-577-8321
Mailing Address - Fax:310-577-8955
Practice Address - Street 1:119 VOYAGE MALL
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7296
Practice Address - Country:US
Practice Address - Phone:310-577-8321
Practice Address - Fax:310-577-8955
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC298552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology