Provider Demographics
NPI:1124299672
Name:S RICK MILLER D P M PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:S RICK MILLER D P M PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICK
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-242-0660
Mailing Address - Street 1:1300 GODWARD ST NE
Mailing Address - Street 2:STE 4100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1741
Mailing Address - Country:US
Mailing Address - Phone:972-242-0660
Mailing Address - Fax:972-242-7596
Practice Address - Street 1:2150 N JOSEY LN
Practice Address - Street 2:#202
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2991
Practice Address - Country:US
Practice Address - Phone:972-242-0660
Practice Address - Fax:972-242-7596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0562213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124299672OtherNPI
TX0927527-02Medicaid
TX0AP08Medicare PIN
TX1124299672OtherNPI
TX0927527-02Medicaid