Basic Information
| Provider Information | |||||||||
| NPI: | 1912970542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | PAMELA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14575 TAMIAMI TRL | ||||||||
| Address2: | ATTEN MEDICAL STAFF SERVICES | ||||||||
| City: | NORTH PORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342872729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414293400 | ||||||||
| FaxNumber: | 9414293430 | ||||||||
| Practice Location | |||||||||
| Address1: | 14575 TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | NORTH PORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342872729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414293400 | ||||||||
| FaxNumber: | 9414293430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 10/24/2013 | ||||||||
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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 | AC5582919 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6005200 | 05 | SD | MEDICAID |