Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 41017 | MN |
Y | 2080P0205X | Pediatric Endocrinologist | 41017 | MN |
NPI | 1184633059 |
---|---|
Provider Name | Bradley Miller |
First Address | Minneapolis, MN 55455 |
Second Address | Minneapolis, MN 55455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 23/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006136 | (05) | MT |
006136 | (05) | WI |
126279 | UCARE (01) | |
33-00031 | MEDICA PRIMARY (01) | |
33-00127 | MEDICA CHOICE/SELECT CARE (01) | |
548A4MI | BCBS-MN (01) | MN |
930078007 | MN RR (01) | MN |
96198101860 | PREFERRED ONE (01) | |
HP27040 | HEALTHPARTNERS (01) | |
PHCS | 929357 (01) |