Provider Demographics
NPI:1184205411
Name:MILLER, MADISON ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ELLIS
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT
Mailing Address - Street 2:2799 W. GRAND BOULEVARD
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT
Practice Address - Street 2:2799 W. GRAND BOULEVARD
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-1023
Practice Address - Fax:313-916-9713
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program