Provider Demographics
NPI:1164861308
Name:MILLER, CHARLES ROHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROHAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W CENTRAL AVE
Mailing Address - Street 2:#200
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3800
Mailing Address - Country:US
Mailing Address - Phone:419-291-2051
Mailing Address - Fax:419-479-6952
Practice Address - Street 1:2100 W CENTRAL AVE
Practice Address - Street 2:#200
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3800
Practice Address - Country:US
Practice Address - Phone:419-291-2051
Practice Address - Fax:419-479-6952
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine