Provider Demographics
NPI:1316958085
Name:MILLER, TRAVIS AARON (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:AARON
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 EXPOSITION BLVD
Mailing Address - Street 2:BLDG 700
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-736-3408
Mailing Address - Fax:916-233-4171
Practice Address - Street 1:1528 EUREKA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3047
Practice Address - Country:US
Practice Address - Phone:916-736-6644
Practice Address - Fax:916-774-0143
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73408207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA113314Medicare PIN