Provider Demographics
NPI:1891821708
Name:MILLER, BERNADETTE M (MD)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5538 S CINCINNATI AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6706
Mailing Address - Country:US
Mailing Address - Phone:918-742-0353
Mailing Address - Fax:
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4152
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK24595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine