Miller, Mary E
Miller, Mary E is an individual health care provider with primary practice located at 200 E Tyranena Park Rd , Lake Mills WI 53551-9678. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Miller, Mary E can be contacted via phone (920) 648-3113.Contact Information
Primary practice address
200 E Tyranena Park Rd
Lake Mills WI 53551-9678
Phone: (920) 648-3113
Fax: (920) 648-3656
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 4301070306 | Michigan |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 50074-020 | Wisconsin |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 50074-20 | Wisconsin |
Profile Details
| NPI number | 1356411292 |
|---|---|
| LBN Legal business name | Miller, Mary E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 8th, 2006 |
| Last updated | Jul 31st, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356411292 | NPPES |
| Wisconsin | MEDICAID | 34759800 | |
| Wisconsin | MEDICAID | 118658200 |
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