Provider Demographics
NPI:1588692511
Name:MILLER, LORI (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1650 PARK LANE DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:303-673-0296
Mailing Address - Fax:
Practice Address - Street 1:7450 E 52ND AVE
Practice Address - Street 2:UINT H
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002
Practice Address - Country:US
Practice Address - Phone:800-819-8566
Practice Address - Fax:303-463-5951
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34542207Q00000X
COCO34542207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18050859Medicaid
CO18050859Medicaid
CO522498Medicare PIN