Provider Demographics
NPI:1992773477
Name:MILLER, HOWARD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MICHAEL
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44650 VILLAGE CT
Mailing Address - Street 2:100
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3812
Mailing Address - Country:US
Mailing Address - Phone:760-346-4003
Mailing Address - Fax:760-346-4443
Practice Address - Street 1:44650 VILLAGE CT
Practice Address - Street 2:100
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3812
Practice Address - Country:US
Practice Address - Phone:760-346-4003
Practice Address - Fax:760-346-4443
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27597174400000X, 207N00000X
IN01070085A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201029620Medicaid
IN000000724503OtherANTHEM PROVIDER NUMBER
IN201029620Medicaid
IN201029620Medicaid
CA95-3539809OtherTAX ID NUMBER