Provider Demographics
NPI:1285738757
Name:MILLER, ANGELA C (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-2000
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092497208000000X
WI32036208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
390808509OtherWPS
10887OtherDEAN HEALTH PLAN
31715500OtherHIRSP
690004890OtherMEDICARE RAILROAD
L90543OtherMEDICARE
370004380OtherMEDICARE RAILROAD
390808509OtherCT GENERAL
39080850911OtherUNITY
90002361OtherWEA INS
WI31715500Medicaid
1000258OtherPHYSICIANS PLUS
390808509OtherCIGNA
390808509ADOtherUNITY