Provider Demographics
NPI:1063867356
Name:NEUMANN, MILES ROSS (DO)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:ROSS
Last Name:NEUMANN
Suffix:
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 1:29201 TELEGRAPH RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7648
Mailing Address - Country:US
Mailing Address - Phone:248-569-5985
Mailing Address - Fax:
Practice Address - Street 1:29201 TELEGRAPH RD STE 500
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7648
Practice Address - Country:US
Practice Address - Phone:248-569-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022208207YS0123X
MI5101026170207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101026170OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI5101022208OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS