Provider Demographics
NPI:1700868353
Name:MILLER, LINDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6989 E FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1714
Mailing Address - Country:US
Mailing Address - Phone:813-935-4210
Mailing Address - Fax:813-932-7940
Practice Address - Street 1:316 NURSING HOME DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-3870
Practice Address - Country:US
Practice Address - Phone:863-993-7717
Practice Address - Fax:863-491-4215
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5318174400000X
FLME112763208600000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7301920Medicaid
G57420Medicare UPIN
41759Medicare ID - Type Unspecified