Provider Demographics
NPI:1750465910
Name:MILLER, KEVIN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 TAMIAMI TRL S
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4133
Mailing Address - Country:US
Mailing Address - Phone:941-488-2332
Mailing Address - Fax:941-894-6230
Practice Address - Street 1:1101 TAMIAMI TRL S
Practice Address - Street 2:SUITE 108
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4133
Practice Address - Country:US
Practice Address - Phone:941-488-2332
Practice Address - Fax:941-894-6230
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72995207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
57524ZMedicare ID - Type Unspecified
G29784Medicare UPIN