Provider Demographics
NPI:1548451610
Name:KEVIN L MILLER MD, PA
Entity type:Organization
Organization Name:KEVIN L MILLER MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-819-9910
Mailing Address - Street 1:700 SAN GABRIEL VILLAGE BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5594
Mailing Address - Country:US
Mailing Address - Phone:512-819-9910
Mailing Address - Fax:512-819-9970
Practice Address - Street 1:700 SAN GABRIEL VILLAGE BLVD
Practice Address - Street 2:STE 105
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5594
Practice Address - Country:US
Practice Address - Phone:512-819-9910
Practice Address - Fax:512-819-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1393207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283939OtherSCOTT AND WHITE
TX7524367OtherAETNA
TXDA4188OtherRAIL ROAD MEDICARE
TX7524367OtherAETNA