1285738757 NPI number — ANGELA C MILLER MD

Table of content: ANGELA C MILLER MD (NPI 1285738757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285738757 NPI number — ANGELA C MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
ANGELA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285738757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 22ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53566-1569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-324-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 22ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53566-1569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-324-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  036-092497 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 32036 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 390808509 . This is a "WPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10887 . This is a "DEAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31715500 . This is a "HIRSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 690004890 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: L90543 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 370004380 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390808509 . This is a "CT GENERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39080850911 . This is a "UNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90002361 . This is a "WEA INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31715500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000258 . This is a "PHYSICIANS PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390808509 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390808509AD . This is a "UNITY" identifier . This identifiers is of the category "OTHER".