Organization
GRAND FORKS FOOT AND ANKLE CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN CARLYLE MILLER DPM (PRESIDENT)
(701) 738-2770
Entity
Organization
Contact information
Practice address
1451 44TH AVE S STE 128D, GRAND FORKS, ND 58201-3434
(701) 738-2770
Mailing address
1451 44TH AVE S STE 128D, GRAND FORKS, ND 58201-3434
(701) 738-2770
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
48
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06740-001
BLURE CROSS BLUE SHIELD
ND
05
—
13707
—
ND
Enumeration date
04/16/2007
Last updated
03/14/2008
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