Miles Med Management Service Corporation

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MILES MED MANAGEMENT SERVICE CORPORATION

Doing business as

Miles Med Management

Practice address

5775 Wayzata Blvd Ste 767
Saint Louis Park, MN 55416-1222

Phone

(612) 708-7562

Fax

(507) 738-1963

NPI assigned

Aug 16, 2021

Last updated

Sep 15, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Ann Miles, APNPNPI 1093741886

Title

Nurse Practitioner

Phone

(612) 708-7562

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Miles Med Management Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Ann Miles, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Minneapolis, MN
  • NPI 1093741886
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1225703705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 ELLIOT AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073156",
            "telephone_number": "612-708-7562",
            "fax_number": "507-738-1963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5775 WAYZATA BLVD STE 767",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554161222",
            "telephone_number": "612-708-7562",
            "fax_number": "507-738-1963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILES MED MANAGEMENT SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-16",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "MILES",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "612-708-7562",
        "authorized_official_credential": "APNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225703705",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093741886",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Miles Med Management",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Miles Med Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joan Mielke
• Erin Michelle Miers, PSYD
• Adam Mikelson, LICSW
• Maren Milbert
• Jodi Milburn
• Dorit Miles
• Glenda Miles, RN
• Mill City Mental Health
• Jennifer Malinosky Millard
• Georgia Miller-Kamara

• Psychiatric/Mental Health Nurse Practitioner in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.