Provider Demographics
NPI:1740264852
Name:MILLER, MARY K (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1695 N SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-3701
Mailing Address - Country:US
Mailing Address - Phone:760-323-2118
Mailing Address - Fax:760-416-1651
Practice Address - Street 1:1695 N SUNRISE WAY
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-3701
Practice Address - Country:US
Practice Address - Phone:760-323-2118
Practice Address - Fax:760-416-1651
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG52799207V00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G527990Medicaid
CAA52353Medicare UPIN
CA00G527990Medicaid