Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 57834 | MN |
N | 207ND0900X | Dermatopathologist | 57834 | MN |
NPI | 1770745978 |
---|---|
Provider Name | Dr. Daniel David Miller |
First Address | Minneapolis, MN 55413-2614 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2008 |
Last Update Date | 16/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110091721A | (05) | MA |