Provider Demographics
NPI:1710961909
Name:MILLER, ANDREA B (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:MILLER
Suffix:
Gender:F
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:520-290-0300
Mailing Address - Fax:520-298-9230
Practice Address - Street 1:1669 W INA RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1976
Practice Address - Country:US
Practice Address - Phone:520-795-6183
Practice Address - Fax:520-298-9230
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110247583OtherRR MEDICARE
106517OtherPACIFICARE SECURE HORIZON
1Z9370OtherHEALTHNET
860780125OtherCIGNA
AZ0839620OtherBLUE CROSS BLUE SHIELD
AZ0728510OtherBLUE CROSS BLUE SHIELD
AZ860780125OtherUNITED HEALTHCARE
AZZ189361Medicare PIN
860780125OtherCIGNA
72939Medicare ID - Type Unspecified