Provider Demographics
NPI:1740582444
Name:TIMOTHY A. MILLER, MD, INC
Entity Type:Organization
Organization Name:TIMOTHY A. MILLER, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:CASILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-825-5898
Mailing Address - Street 1:200 UCLA MEDICAL PLZ
Mailing Address - Street 2:SUITE 465
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-6960
Mailing Address - Country:US
Mailing Address - Phone:310-825-5644
Mailing Address - Fax:310-206-4190
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE 465
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-6960
Practice Address - Country:US
Practice Address - Phone:310-825-5644
Practice Address - Fax:310-206-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21438208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEY092AMedicare PIN