Provider Demographics
NPI:1154397297
Name:MILLER, MONICA (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 GREENBRANCH DR
Mailing Address - Street 2:BLDG 2, STE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6797
Mailing Address - Country:US
Mailing Address - Phone:813-866-4626
Mailing Address - Fax:813-972-8866
Practice Address - Street 1:2318 GREENBRANCH DR
Practice Address - Street 2:BLDG 2, STE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6797
Practice Address - Country:US
Practice Address - Phone:813-866-4626
Practice Address - Fax:813-972-8866
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224871208200000X
FLME1300202082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110041519AMedicaid
MA110041519AMedicaid
MA110041519AMedicaid