Provider Demographics
NPI:1063642205
Name:MILLER, JOHN KEVIN (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KEVIN
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 1:330 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7726
Mailing Address - Country:US
Mailing Address - Phone:606-325-6493
Mailing Address - Fax:606-324-9101
Practice Address - Street 1:330 21ST ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7726
Practice Address - Country:US
Practice Address - Phone:833-409-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094459208600000X
KY46681208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2996638Medicaid
KY7100272220Medicaid
OH4285691Medicare PIN
KY7100272220Medicaid