Provider Demographics
NPI:1962732180
Name:MADELINE L MILLER MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MADELINE L MILLER MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-721-4161
Mailing Address - Street 1:2600 E COAST HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2117
Mailing Address - Country:US
Mailing Address - Phone:949-721-4161
Mailing Address - Fax:949-717-0137
Practice Address - Street 1:2600 E COAST HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2117
Practice Address - Country:US
Practice Address - Phone:949-721-4161
Practice Address - Fax:949-717-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50252207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty