Provider Demographics
NPI:1285126250
Name:TOMMERAASEN, MILES AUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:AUSTIN
Last Name:TOMMERAASEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MEDICAL PARK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0939
Mailing Address - Country:US
Mailing Address - Phone:704-786-1108
Mailing Address - Fax:704-782-1826
Practice Address - Street 1:200 MEDICAL PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0939
Practice Address - Country:US
Practice Address - Phone:704-786-1108
Practice Address - Fax:704-782-1826
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2024-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2024-03145208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery