Provider Demographics
NPI:1437253176
Name:MILLER, DAVID K (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
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 1:15905 E OKLAHOMA ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74116-2408
Mailing Address - Country:US
Mailing Address - Phone:580-223-9355
Mailing Address - Fax:
Practice Address - Street 1:15905 E OKLAHOMA ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74116-2408
Practice Address - Country:US
Practice Address - Phone:580-223-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23886207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200029260AMedicaid
OK1437253176Medicare PIN
OK200029260AMedicaid