Provider Demographics
NPI:1356785059
Name:ROBERTI MILLER, ADRIA LARA (DO)
Entity type:Individual
Prefix:
First Name:ADRIA
Middle Name:LARA
Last Name:ROBERTI MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ADRIA
Other - Middle Name:LARA
Other - Last Name:ROBERTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:23050 WEST RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1472
Mailing Address - Country:US
Mailing Address - Phone:585-737-8369
Mailing Address - Fax:
Practice Address - Street 1:1815 S CLINTON AVE STE 310
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-473-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293517-1208000000X
MI5315075719208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics