Mary E Miller, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

50074-20 Issued in WI

Practice address

200 E Tyranena Park Rd
Lake Mills, WI 53551-9678

Phone

(920) 648-3113

Fax

(920) 648-3656

NPI assigned

Nov 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343692800000",
    "number": "1356411292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E TYRANENA PARK RD",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535519678",
            "telephone_number": "920-648-3113",
            "fax_number": "920-648-3656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E TYRANENA PARK RD",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535519678",
            "telephone_number": "920-648-3113",
            "fax_number": "920-648-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2012-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301070306",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "50074-020",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "50074-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34759800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118658200",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McKenna Meihak, APNP
• Brian Joseph Meitner, L.A.T.
• Katherine Mennenga, OTR, OTD
• Allison Mertens, RN
• Brenna Elizabeth Meyer, DPT
• Alyssa Kelli Murfield, PTA
• NSH Lake Mills LLC
• Opening Doors Together, LLC
• Optimal Physical Therapy, LLC
• Oral Health Clinic Inc

• Family Medicine Physician in Lake Mills, WI
• Providers in Lake Mills, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; 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.