Provider Demographics
NPI:1073606745
Name:MILLER, MATTHEW GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GRANT
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 1:770 SIMMS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-4702
Mailing Address - Country:US
Mailing Address - Phone:303-635-6337
Mailing Address - Fax:303-862-7953
Practice Address - Street 1:770 SIMMS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-4702
Practice Address - Country:US
Practice Address - Phone:303-635-6337
Practice Address - Fax:303-862-7953
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO358052083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO40850Medicare UPIN
COCOB4545Medicare PIN