Provider Demographics
NPI:1225032964
Name:MILLER, MATTHEW W (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
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 1:140 FOX RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2475
Mailing Address - Country:US
Mailing Address - Phone:419-232-2077
Mailing Address - Fax:419-232-4498
Practice Address - Street 1:140 FOX RD
Practice Address - Street 2:SUITE 202
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2475
Practice Address - Country:US
Practice Address - Phone:419-238-6735
Practice Address - Fax:419-232-5271
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH78450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2197224Medicaid
OH4026213Medicare PIN
OHMI4026211Medicare ID - Type UnspecifiedMEDICARE NUMBER