Basic Information
| Provider Information | |||||||||
| NPI: | 1699883538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DARRYL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 OKEECHOBEE BLVD | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334016349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618040200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 525 OKEECHOBEE BLVD | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334016349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618040200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35075929M | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2361313 | 05 | OH | MEDICAID | 000000325015 | 01 | ANTHEM | OTHER | 34192070200 | 01 | OH | BWC | OTHER | 7841380 | 01 | AETNA HMO/NON HMO | OTHER |