Provider Demographics
NPI:1417953563
Name:MILLER, HAROLD W (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:210 W 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-2251
Practice Address - Country:US
Practice Address - Phone:563-386-3240
Practice Address - Fax:563-386-3211
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA19332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
40199OtherWELLMARK BC/BS
034791OtherHEALTH ALLIANCE
19971OtherIOWA HEALTH SOLUTIONS
IA4143651Medicaid
4796890009OtherDMERC
IA0146OtherJOHN DEERE HEALTH PLAN
IA0146OtherJOHN DEERE HEALTH PLAN
IA4143651Medicaid