Provider Demographics
NPI:1124004684
Name:MILLER, KRISTIN L (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-3557
Mailing Address - Country:US
Mailing Address - Phone:608-314-3600
Mailing Address - Fax:608-314-3601
Practice Address - Street 1:3400 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-3557
Practice Address - Country:US
Practice Address - Phone:608-314-3600
Practice Address - Fax:608-314-3601
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55333-21207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124004684Medicaid
WI61176OtherDEAN HEALTH INSURANCE
WI61176OtherDEAN HEALTH INSURANCE
WI1124004684Medicaid