Provider Demographics
NPI:1285860510
Name:MILLER, KELLY MARIE (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 HOSPITAL DR STE 4500
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9693
Mailing Address - Country:US
Mailing Address - Phone:614-788-0588
Mailing Address - Fax:614-788-0587
Practice Address - Street 1:7450 HOSPITAL DR STE 4500
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9693
Practice Address - Country:US
Practice Address - Phone:614-788-0588
Practice Address - Fax:614-788-0587
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34010501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065182Medicaid
OHH096340Medicare PIN