Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME72995 | FL |
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME72995 | FL |
NPI | 1750465910 |
---|---|
Provider Name | Dr. Kevin James Miller |
First Address | Venice, FL 34285-4133 |
Second Address | Venice, FL 34285-4133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 11/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G29784 | (02) |