Provider Demographics
NPI:1730124710
Name:MILLER, KARL A (DO)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-879-3000
Mailing Address - Fax:
Practice Address - Street 1:19 S GORHAM XING
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-2690
Practice Address - Country:US
Practice Address - Phone:207-839-9101
Practice Address - Fax:207-839-9201
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME275630099Medicaid
MP713554OtherHARVARD
M72985OtherCIGNA
ME3415207OtherAETNA
ME02293OtherANTHEM
P00153895OtherRAILROAD
M72985OtherCIGNA
MEMM4744Medicare ID - Type Unspecified
P00153895OtherRAILROAD