Provider Demographics
NPI:1952543886
Name:MILLER, NATHAN MALCOLM (DPM)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:MALCOLM
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1510 S CENTRAL AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2500
Mailing Address - Country:US
Mailing Address - Phone:818-242-3668
Mailing Address - Fax:818-242-2425
Practice Address - Street 1:1510 S CENTRAL AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2500
Practice Address - Country:US
Practice Address - Phone:818-242-3668
Practice Address - Fax:818-242-2425
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 15317111N00000X
CAE3770213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No111N00000XChiropractic ProvidersChiropractor