Provider Demographics
NPI:1811172547
Name:MILLER, WENDI S (MD)
Entity type:Individual
Prefix:DR
First Name:WENDI
Middle Name:S
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 1:90290 OVERSEAS HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2263
Mailing Address - Country:US
Mailing Address - Phone:305-453-6097
Mailing Address - Fax:305-735-4014
Practice Address - Street 1:90290 OVERSEAS HWY STE 105
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2263
Practice Address - Country:US
Practice Address - Phone:305-453-6097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070913A207P00000X
AZ65580207P00000X
GA062066207P00000X
MI4301095881207P00000X
FLME110810207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100244980Medicaid
OH0378599Medicaid
OH0021491Medicaid