Provider Demographics
NPI:1427048313
Name:MILLER, MARK STEVE (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 EL CAMINO REAL
Mailing Address - Street 2:STE B #311
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1819
Mailing Address - Country:US
Mailing Address - Phone:702-524-0367
Mailing Address - Fax:760-943-8816
Practice Address - Street 1:1512 GREEN OAK RD
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8740
Practice Address - Country:US
Practice Address - Phone:702-524-0367
Practice Address - Fax:760-943-8816
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4588213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4588Medicare ID - Type Unspecified
NVV32869Medicare PIN
NVU52247Medicare UPIN