Basic Information
| Provider Information | |||||||||
| NPI: | 1558656090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK MILLER MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 W CENTRAL AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928213032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149961633 | ||||||||
| FaxNumber: | 7149969267 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 FAIRMOUNT AVE | ||||||||
| Address2: | STE 205 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264051513 | ||||||||
| FaxNumber: | 6264491166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2011 | ||||||||
| LastUpdateDate: | 06/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | EDMUND | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6264051513 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | A76869 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.