Provider Demographics
NPI:1417922568
Name:MILLER, ANTHONY W (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
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 1:451 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-8242
Mailing Address - Country:US
Mailing Address - Phone:269-655-3080
Mailing Address - Fax:269-655-0761
Practice Address - Street 1:451 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-8242
Practice Address - Country:US
Practice Address - Phone:269-655-3080
Practice Address - Fax:269-655-0761
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4950761Medicaid
MI238601OtherMEDICARE RURAL HEALTH CLINIC NUMBER
MI4790210Medicaid
MICA4396OtherRAILROAD MEDICARE
MICA2184OtherRAILROAD MEDICARE
MI238601OtherMEDICARE RURAL HEALTH CLINIC NUMBER
MICA4396OtherRAILROAD MEDICARE
MICA2184OtherRAILROAD MEDICARE