Basic Information
| Provider Information | |||||||||
| NPI: | 1205046646 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MERIDA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 33RD AVE S | ||||||||
| Address2: | PO BOX 1309 MAIL STOP 21110Q | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554254516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529938900 | ||||||||
| FaxNumber: | 9529938955 | ||||||||
| Practice Location | |||||||||
| Address1: | 4155 CTY RD 101 N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529938900 | ||||||||
| FaxNumber: | 9529938955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 03/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | R-7121 | IA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 37302 | IA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 58634 | MN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 56646 | 01 | IA | WELLMARK BCBS | OTHER |