Provider Demographics
NPI:1497838684
Name:MILLER, GEORGE E (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1673
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:580 S LOOP RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3415
Practice Address - Country:US
Practice Address - Phone:859-344-1600
Practice Address - Fax:859-344-0091
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17684174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY021530786OtherTRAVELERS MEDICARE
KY1700954OtherUNITED HEALTHCARE
KYP00819403OtherRR MEDICARE - KENTUCKY
KY64176845Medicaid
KY1459529OtherNGS MEDICARE PIN/PTAN
1497838684OtherNPI
KY000000046085OtherANTHEM
KY0673365OtherAETNA
KY1700954OtherUNITED HEALTHCARE
KY000000046085OtherANTHEM
KY1459529OtherNGS MEDICARE PIN/PTAN