Provider Demographics
NPI:1992107908
Name:MILLER, PHYL-KIA
Entity type:Individual
Prefix:
First Name:PHYL-KIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18730 VAN HORN RD
Mailing Address - Street 2:APT 202
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3879
Mailing Address - Country:US
Mailing Address - Phone:734-795-0119
Mailing Address - Fax:
Practice Address - Street 1:18730 VAN HORN RD
Practice Address - Street 2:APT 202
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3879
Practice Address - Country:US
Practice Address - Phone:734-795-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other