Provider Demographics
NPI:1861488702
Name:MILLER, FREDERICK CARLTON (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:CARLTON
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-750-0822
Mailing Address - Fax:303-750-1298
Practice Address - Street 1:1444 S POTOMAC ST
Practice Address - Street 2:#300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4508
Practice Address - Country:US
Practice Address - Phone:303-750-0822
Practice Address - Fax:303-750-1298
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23295207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026281000Medicaid
NE10026283100Medicaid
WY101694600Medicaid
NE10026280800Medicaid
NE10026282600Medicaid
NE10026281200Medicaid
NE100262823-00Medicaid
NE10026283000Medicaid
NE1982948089Medicaid
CO01232958Medicaid
NE10026280700Medicaid
KS100207400FMedicaid
CO01232958Medicaid
WY101694600Medicaid
NENA2301001Medicare PIN
NE10026281000Medicaid
NE10026280700Medicaid
NE10026283000Medicaid
KSKA2848001Medicare PIN