Provider Demographics
NPI:1093701476
Name:MILLER, ANDREW WADE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WADE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 UNION AVE
Mailing Address - Street 2:SUITE 147
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3004
Mailing Address - Country:US
Mailing Address - Phone:330-339-6233
Mailing Address - Fax:330-343-8460
Practice Address - Street 1:515 UNION AVE
Practice Address - Street 2:SUITE 147
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3004
Practice Address - Country:US
Practice Address - Phone:330-339-6233
Practice Address - Fax:330-343-8460
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3392213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2642537Medicaid
OHP00662344OtherRAILROAD
OH9378401OtherMEDICARE GROUP NUMBER
OH2642537Medicaid
OH4182024Medicare PIN
OH5378920003Medicare NSC
OHP00310677OtherRAILROAD MEDICARE
OH5378920001Medicare NSC
OH9339961Medicare PIN