Provider Demographics
NPI:1982672952
Name:MILLER, RASA K (MD)
Entity Type:Individual
Prefix:
First Name:RASA
Middle Name:K
Last Name: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 1:22720 BUCKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-2711
Mailing Address - Country:US
Mailing Address - Phone:205-481-8640
Mailing Address - Fax:205-477-6214
Practice Address - Street 1:22720 BUCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-2711
Practice Address - Country:US
Practice Address - Phone:205-481-8640
Practice Address - Fax:205-477-6214
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35987207Q00000X
NH15544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH002834701Medicare PIN
OH4159221Medicare ID - Type Unspecified
I30549Medicare UPIN
NH32001603Medicaid
I30549Medicare UPIN