Individual
LISA D MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
910 WALLACE AVE, LEITCHFIELD, KY 42754
(270) 259-9651
(270) 259-0346
Mailing address
908 WALLACE AVE, LEITCHFIELD, KY 42754-1479
(270) 259-9651
(270) 259-0346
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35596
TN
207R00000X
Internal Medicine Physician
Primary
44680
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3866106
—
TN
05
—
7100181130
—
KY
Enumeration date
09/14/2005
Last updated
05/12/2020
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