Provider Demographics
NPI:1134509144
Name:MILLER, JASON P (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY PEDIATRICIANS
Mailing Address - Street 2:4201 ST. ANTOINE - UHC 5D MAILBOX 226
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:CHILDREN'S HOSPITAL OF MI
Practice Address - Street 2:3901 BEAUBIEN
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5260
Practice Address - Fax:313-966-0665
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301116121208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics