Provider Demographics
NPI:1487655007
Name:MILLER, STEPHEN C (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
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 1:7182 WOODROW ST STE 200
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2832
Mailing Address - Country:US
Mailing Address - Phone:803-749-1111
Mailing Address - Fax:803-749-0050
Practice Address - Street 1:416 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2952
Practice Address - Country:US
Practice Address - Phone:843-549-9787
Practice Address - Fax:843-549-2709
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2019-07-13
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
SC11871207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11871OtherSC LICENSE
SC118713Medicaid
SC11871OtherSC LICENSE
SCD05594Medicare UPIN
SC118713Medicaid