Provider Demographics
NPI:1851338099
Name:EDWARDS-MILLER, MYRIAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:A
Last Name:EDWARDS-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 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:1714 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1227
Practice Address - Country:US
Practice Address - Phone:352-509-9900
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129752207RG0300X
MI4301057840207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F85681Medicare UPIN
MI700B510700OtherBCBSM GROUP FOR HURLEY HEALTH SERVICES
F85681Medicare UPIN