Provider Demographics
NPI:1457316457
Name:MILLER, LLOYD G JR (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:G
Last Name:MILLER
Suffix:JR
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9342 CEDAR CENTER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291
Practice Address - Country:US
Practice Address - Phone:502-239-3228
Practice Address - Fax:502-231-2517
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2436733000OtherPASSPORT ADVANTAGE / NMA
000000350661OtherANTHEM / NMA
009695OtherSHIO / NMA
2546383003OtherCIGNA / NMA
KY50067870OtherPASSPORT/NMA
KY64264252Medicaid
KYP00186667OtherRAILROAD MEDICARE
0000521551OtherHUMANA / NMA
1193580OtherCHA / NMA
2436733000OtherPASSPORT ADVANTAGE / NMA
KY64264252Medicaid