Provider Demographics
NPI:1275509911
Name:MILLER, SANDRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
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 1:237 WILLIAM HOWARD TAFT, PHYS DIV
Mailing Address - Street 2:2ND FL, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-263-8571
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 442
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-721-8272
Practice Address - Fax:513-721-0333
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS31135208600000X
OH35-0781312086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2183051OtherMEDICAID
OH5902567OtherAETNA
OH270577733067OtherCARESOURCE
OH763200OtherANTHEM
OHH109180OtherMEDICARE
OH681757OtherWELLCARE
OH1630469OtherGATEWAY HEALTH
KS200310530AMedicaid
OHP01239196OtherRAILROAD MEDICARE
IN200304120OtherMEDICAID
OH1630469OtherGATEWAY HEALTH
OH763200OtherANTHEM
IN200304120OtherMEDICAID