Provider Demographics
NPI:1285613331
Name:MILLER, LEE PATRICK (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:PATRICK
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:L.
Other - Middle Name:PATRICK
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4201 SOUTH MINNESOTA AVENUE
Mailing Address - Street 2:STE 112
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6706
Mailing Address - Country:US
Mailing Address - Phone:605-335-3349
Mailing Address - Fax:605-336-8436
Practice Address - Street 1:4201 SOUTH MINNESOTA AVENUE
Practice Address - Street 2:STE 112
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6706
Practice Address - Country:US
Practice Address - Phone:605-335-3349
Practice Address - Fax:605-336-8436
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD40922086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0919563Medicaid
MN124216400Medicaid
NE10025286300Medicaid
240005059OtherRAILROAD MEDICARE
SD7301460Medicaid
SD7301460Medicaid
S100415Medicare PIN