Provider Demographics
NPI:1588402903
Name:MILLER, CRAIG STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STANLEY
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 1:20206 VIA MADRIGAL
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4447
Mailing Address - Country:US
Mailing Address - Phone:818-486-4925
Mailing Address - Fax:818-998-3522
Practice Address - Street 1:20206 VIA MADRIGAL
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4447
Practice Address - Country:US
Practice Address - Phone:818-486-4925
Practice Address - Fax:818-998-3522
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-26537207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine