Provider Demographics
NPI:1144299678
Name:MILLER, NATASHA (MD)
Entity type:Individual
Prefix:
First Name:NATASHA
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 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5171
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:315 E ELM
Practice Address - Street 2:STE 100
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4858
Practice Address - Country:US
Practice Address - Phone:208-459-7415
Practice Address - Fax:208-453-3307
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30301208000000X
IDM-10367208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ712598Medicaid
ID11003361Medicare UPIN