Provider Demographics
NPI:1881181881
Name:MILLER AESTHETIC MEDICINE, LLC
Entity Type:Organization
Organization Name:MILLER AESTHETIC MEDICINE, LLC
Other - Org Name:MILLER AESTHETIC MEDICINE, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:MEDICINE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-517-6957
Mailing Address - Street 1:90290 OVERSEAS HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2263
Mailing Address - Country:US
Mailing Address - Phone:305-517-6957
Mailing Address - Fax:
Practice Address - Street 1:90290 OVERSEAS HWY STE 106
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2263
Practice Address - Country:US
Practice Address - Phone:305-517-6957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332900000XSuppliersNon-Pharmacy Dispensing Site