Provider Demographics
NPI:1700830007
Name:MILES, ROBERT LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LESLIE
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 1:52 MEDICAL PARK DR E
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3430
Mailing Address - Country:US
Mailing Address - Phone:205-838-3047
Mailing Address - Fax:205-838-3497
Practice Address - Street 1:52 MEDICAL PARK DR E
Practice Address - Street 2:SUITE 307
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3430
Practice Address - Country:US
Practice Address - Phone:205-838-3047
Practice Address - Fax:205-838-3497
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15253174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060135OtherMEDICAID GROUP NUMBER
AL000082193Medicaid
AL1982796603OtherGROUP NPI
AL1700830007OtherMEDICARE INDIVUAL NPI
ALC135OtherMEDICARE GROUP (OLD)
AL1982796603OtherGROUP NPI
AL000082193Medicare ID - Type Unspecified
AL000082193Medicaid