Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME93288 | FL |
N | 207ND0900X | Dermatopathologist | 070481 | GA |
N | 207NP0225X | Pediatric Dermatologist | 070481 | GA |
N | 207NS0135X | Procedural Dermatology | 070481 | GA |
N | 208D00000X | General Practice Physician | 070481 | GA |
NPI | 1518126218 |
---|---|
Provider Name | Dr. Luke Michael Miller |
First Address | Lakeland, FL 33805-3019 |
Second Address | Lakeland, FL 33813-3825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 22/09/2020 |