Provider Demographics
NPI:1811986201
Name:MILLER, KARIN L (MD)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:L
Other - Last Name:WOLFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 AVENUE K SE STE 6
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4123
Mailing Address - Country:US
Mailing Address - Phone:863-299-4567
Mailing Address - Fax:863-297-9750
Practice Address - Street 1:400 AVENUE K SE STE 6
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4123
Practice Address - Country:US
Practice Address - Phone:863-229-4567
Practice Address - Fax:863-297-9750
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43996208000000X
TN35487208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00978623BMedicaid