Provider Demographics
NPI:1588924740
Name:MILLER, MICHAEL J (NMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42007 N NEW RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-6550
Mailing Address - Country:US
Mailing Address - Phone:602-828-2141
Mailing Address - Fax:
Practice Address - Street 1:42007 N NEW RIVER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-6550
Practice Address - Country:US
Practice Address - Phone:602-828-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12-1313175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath