Provider Demographics
NPI:1295709285
Name:MILLER, HOWARD CHARLES (DPM)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:CHARLES
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336
Mailing Address - Country:US
Mailing Address - Phone:209-823-9378
Mailing Address - Fax:209-823-9971
Practice Address - Street 1:1210 E NORTH ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336
Practice Address - Country:US
Practice Address - Phone:209-823-9378
Practice Address - Fax:209-823-9971
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1846213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E18461Medicaid
T11075Medicare UPIN
CA5826450001Medicare NSC