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Organization
MILLER ORTHOPAEDIC AFFILIATES PC
Active
Organization
MILLER ORTHOPAEDIC AFFILIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL J. LAROSE MD (PRESIDENT)
(712) 323-5333
Entity
Organization
Contact information
Practice address
1 EDMUNDSON PLACE, SUITE 500, COUNCIL BLUFFS, IA 51503-4619
(712) 323-5333
(712) 323-3252
Mailing address
1 EDMUNDSON PL, STE 500, COUNCIL BLUFFS, IA 51503-4619
(712) 323-5333
(712) 323-3252
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
2251X0800X
Orthopedic Physical Therapist
—
NULL
2251X0800X
Orthopedic Physical Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332BC3200X
Customized Equipment (DME)
—
NULL
335E00000X
Prosthetic/Orthotic Supplier
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119040
—
IA
05
—
0701830
—
IA
05
—
0701871
—
IA
05
—
0701872
—
IA
05
—
0701873
—
IA
01
—
09602
WELLMARK GRP #
IA
05
—
10025346400
—
NE
Enumeration date
07/13/2005
Last updated
07/16/2012
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