Individual
DR. TRACEY L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5808 W 110TH ST, OVERLAND PARK, KS 66211-2504
(913) 696-8000
(816) 302-9939
Mailing address
2401 GILLHAM RD, PROVIDER ENROLLMENT DEPARTMENT, KANSAS CITY, MO 64108-4619
(816) 234-3000
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0424509
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100143930A
—
KS
01
—
19401018
BCBS KANSAS CITY
—
05
—
205547706
—
MO
01
—
619010
BCBS KANSAS
KS
Enumeration date
09/30/2006
Last updated
07/03/2019
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