Provider Demographics
NPI:1164407037
Name:MILLER, RONALD STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:STANLEY
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN ROAD
Mailing Address - Street 2:385
Mailing Address - City:COLUMBUS
Mailing Address - State:OHIO
Mailing Address - Zip Code:43202
Mailing Address - Country:UM
Mailing Address - Phone:614-947-3700
Mailing Address - Fax:614-947-3771
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-6255
Practice Address - Fax:614-293-8518
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-0685-M207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0454084Medicaid
OHMI4227041Medicare PIN