Provider Demographics
NPI:1992033518
Name:MILLER, MADELINE LOIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:LOIS
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 1:2600 E COAST HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2117
Mailing Address - Country:US
Mailing Address - Phone:949-721-4161
Mailing Address - Fax:
Practice Address - Street 1:2600 E COAST HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2117
Practice Address - Country:US
Practice Address - Phone:949-721-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50252207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology