Basic Information
| Provider Information | |||||||||
| NPI: | 1710961909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 35380 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891335380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202900300 | ||||||||
| FaxNumber: | 5202989230 | ||||||||
| Practice Location | |||||||||
| Address1: | 6365 E TANQUE VERDE RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857153848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202900300 | ||||||||
| FaxNumber: | 5202989230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 03/14/2017 | ||||||||
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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 | 207R00000X | 27713 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 860780125 | 01 | CIGNA | OTHER | AZ0839620 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 110247583 | 01 | RR MEDICARE | OTHER | 1Z9370 | 01 | HEALTHNET | OTHER | AZ0728510 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 106517 | 01 | PACIFICARE SECURE HORIZON | OTHER | AZ860780125 | 01 | UNITED HEALTHCARE | OTHER |