Provider Demographics
NPI:1417098997
Name:MILLER, WILLIAM MAX (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MAX
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 1:602 EMERALD ROAD
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879
Mailing Address - Country:US
Mailing Address - Phone:419-399-2055
Mailing Address - Fax:
Practice Address - Street 1:602 EMERALD ROAD
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879
Practice Address - Country:US
Practice Address - Phone:419-399-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH036734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232377Medicaid
M10405341Medicare ID - Type Unspecified
OH0232377Medicaid