Provider Demographics
NPI:1831109933
Name:MILLER, HART LEGRAND (MD)
Entity type:Individual
Prefix:
First Name:HART
Middle Name:LEGRAND
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-2662 PAHOA VILLAGE RD
Mailing Address - Street 2:SUITE 306 PMB 8741
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-7730
Mailing Address - Country:US
Mailing Address - Phone:808-930-6001
Mailing Address - Fax:808-930-6007
Practice Address - Street 1:15-2662 PAHOA VILLAGE RD
Practice Address - Street 2:SUITE 306 PMB 8741
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-7730
Practice Address - Country:US
Practice Address - Phone:808-930-6001
Practice Address - Fax:808-930-6007
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232571207Q00000X
HI14141207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102215Medicare PIN
HIH102216Medicare PIN
I40078Medicare UPIN
HIH102214Medicare PIN
HIH102213Medicare PIN