Provider Demographics
NPI:1336102615
Name:MILLER, RANDY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:ROBERT
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4970 PARKMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8832
Mailing Address - Country:US
Mailing Address - Phone:614-895-8145
Mailing Address - Fax:
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 3050
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-566-5605
Practice Address - Fax:614-566-6745
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350493622080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0585684Medicaid
OHA16369Medicare UPIN