Provider Demographics
NPI:1174590848
Name:MILLER, CRAIG L (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 E WILDERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6136
Mailing Address - Country:US
Mailing Address - Phone:318-621-2929
Mailing Address - Fax:318-621-2930
Practice Address - Street 1:1449 E BERT KOUNS LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5663
Practice Address - Country:US
Practice Address - Phone:318-629-0220
Practice Address - Fax:318-629-0230
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1975281Medicaid
LA5W968Medicare ID - Type Unspecified
LAG32718Medicare UPIN