Provider Demographics
NPI:1326234568
Name:MILLER, TREVOR JOHN
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:JOHN
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:DEPT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6219
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:DEPT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51864207VM0101X
ILBM9049291207VM0101X
CAC131453207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326234568Medicaid
WI68-086 0373Medicare PIN
WI73601 1844Medicare PIN