Provider Demographics
NPI:1356307490
Name:MILLER, MICHAEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
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 1:7205 ROTHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7415
Mailing Address - Country:US
Mailing Address - Phone:865-588-8508
Mailing Address - Fax:
Practice Address - Street 1:1114 E WEISGARBER RD
Practice Address - Street 2:STE A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2648
Practice Address - Country:US
Practice Address - Phone:865-588-1833
Practice Address - Fax:865-588-8057
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010997174400000X
TNMD10997207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100011924OtherPHP TENNCARE
TN31655207Medicaid
TN2007597OtherBLUE CARE
TN11377084OtherCAQH
TNB03114Medicare UPIN
TN31655207Medicaid