Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD10997 | TN |
N | 207KA0200X | Allergist | MD10997 | TN |
NPI | 1356307490 |
---|---|
Provider Name | Dr. Michael M Miller |
First Address | Knoxville, TN 37919-7415 |
Second Address | Knoxville, TN 37909-2648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100011924 | PHP TENNCARE (01) | TN |
11377084 | CAQH (01) | TN |
2007597 | BLUE CARE (01) | TN |
31655207 | (05) | TN |
B03114 | (02) | TN |