Provider Demographics
NPI:1033182209
Name:MILLER, DENNIS GEORGE I (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GEORGE
Last Name:MILLER
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 GUM AVE
Mailing Address - Street 2:
Mailing Address - City:WELLMAN
Mailing Address - State:IA
Mailing Address - Zip Code:52356-9261
Mailing Address - Country:US
Mailing Address - Phone:319-333-8214
Mailing Address - Fax:
Practice Address - Street 1:1706 W AGENCY RD
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1667
Practice Address - Country:US
Practice Address - Phone:319-768-5858
Practice Address - Fax:319-753-2301
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23276Medicaid
IA23276Medicaid
IAA02839Medicare UPIN
IA23276Medicare ID - Type Unspecified