Individual
MILLER J VAN VLIET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
240 HOSPITAL DR NE, BOLIVIA, NC 28422-8346
(704) 749-5800
(704) 749-5819
Mailing address
200 PROVIDENCE RD, ST. 101, CHARLOTTE, NC 28207-1468
(704) 749-5800
(704) 749-5819
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
200401590
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2035752B
MEDICARE PTAN
NC
01
—
2035752D
MEDICARE PTAN
NC
05
—
89138J9
—
NC
Enumeration date
06/17/2005
Last updated
07/11/2012
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