Provider Demographics
NPI:1144293382
Name:MILLER, ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
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 1:2701 3RD AVE SE
Mailing Address - Street 2:#108
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5465
Mailing Address - Country:US
Mailing Address - Phone:605-228-0402
Mailing Address - Fax:
Practice Address - Street 1:2701 3RD AVE SE
Practice Address - Street 2:#108
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5465
Practice Address - Country:US
Practice Address - Phone:605-228-0402
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD38682084P0800X
OK147302084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDH84248Medicare UPIN