Provider Demographics
NPI:1457581241
Name:MILLER, MATTHEW J (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1104 N MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1017
Mailing Address - Country:US
Mailing Address - Phone:323-343-0647
Mailing Address - Fax:323-225-2752
Practice Address - Street 1:1104 N MISSION RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1017
Practice Address - Country:US
Practice Address - Phone:323-343-0647
Practice Address - Fax:323-225-2752
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA117284207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology