1649200023 NPI number — DR. ALAN KEITH MILLER M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649200023 NPI number — DR. ALAN KEITH MILLER M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MILLER

Provider First Name:

ALAN

Provider Middle Name:

KEITH

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1649200023

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/21/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2234 COLONIAL BLVD

Provider Second Line Business Mailing Address:

ATTN: PAYER CONTRACTING & RELATIONS

Provider Business Mailing Address City Name:

FORT MYERS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33907-1412

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

239-931-7342

Provider Business Mailing Address Fax Number:

239-931-7385

Provider First Line Business Practice Location Address:

200 3RD AVE W

Provider Second Line Business Practice Location Address:

SUITE 210

Provider Business Practice Location Address City Name:

BRADENTON

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

34205-8626

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

941-792-0340

Provider Business Practice Location Address Fax Number:

941-567-3171

Provider Enumeration Date:

07/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208800000X , with the licence number:  4301512961 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208800000X , with the licence number: ME80500 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 012606800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 127097 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P102260 . This is a "FREEDOM HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P512317 . This is a "OPTIMUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 353769 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 7122356 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P01040808 . This is a "RAILROAD MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 1193409 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 81883 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 012606800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".