Provider Demographics
NPI:1013218072
Name:MILLER, STEVEN THOMAS SR
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:THOMAS
Last Name:MILLER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16147 MEYERS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-4108
Mailing Address - Country:US
Mailing Address - Phone:313-345-9950
Mailing Address - Fax:313-345-9952
Practice Address - Street 1:16147 MEYERS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-4108
Practice Address - Country:US
Practice Address - Phone:313-345-9950
Practice Address - Fax:313-345-9952
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0049062Medicaid