Provider Demographics
NPI:1902906373
Name:MILLER, GLENDESE CAMILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENDESE
Middle Name:CAMILLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 NORTH FLAGLER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-882-4541
Mailing Address - Fax:561-650-6093
Practice Address - Street 1:1309 NORTH FLAGLER DRIVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-882-4541
Practice Address - Fax:561-650-6093
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000500660OtherANTHEM BCBS
KY2703533Medicaid
KY000000598137OtherANTHEM BCBS
KY64085814Medicaid
KYP00931051Medicare PIN
KY0642920Medicare PIN
KY000000598137OtherANTHEM BCBS
KY64085814Medicaid