Basic Information
| Provider Information | |||||||||
| NPI: | 1548630643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEVEN A MILES, M.D., A PROFESSIONAL CORPORATION | ||||||||
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| OtherOrganizationName: | BIG THUNDER LOUD RIVER MEDICINE, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8700 BEVERLY BLVD | ||||||||
| Address2: | ROOM AC1042-A | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104237554 | ||||||||
| FaxNumber: | 3106593928 | ||||||||
| Practice Location | |||||||||
| Address1: | 8631 WEST THIRD STREET | ||||||||
| Address2: | SUITE 1017E | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4243639221 | ||||||||
| FaxNumber: | 3102895917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2015 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | MILES | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | ALOYSIUS | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4243639221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | G48908 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.