Provider Demographics
NPI:1336142496
Name:MILLER, DAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:M
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 1:312 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2428
Mailing Address - Country:US
Mailing Address - Phone:270-753-2395
Mailing Address - Fax:270-759-4745
Practice Address - Street 1:312 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2428
Practice Address - Country:US
Practice Address - Phone:270-753-2395
Practice Address - Fax:270-759-4745
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64201189Medicaid
KY000000047165OtherANTHEM
KY000000047165OtherANTHEM
C63575Medicare UPIN