Provider Demographics
NPI:1508806746
Name:MILLER, MICHAEL RAY (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAY
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-1450
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:6130 NOLENSVILLE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6813
Practice Address - Country:US
Practice Address - Phone:615-284-1450
Practice Address - Fax:615-846-1630
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000845207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00760712OtherRR MECICARE
TN4069324OtherBCBS
TN4173180OtherBLUE CROSS BLUE SHIELD
TN33054611Medicaid
TN3319433Medicaid
TN4069324OtherBCBS
TN3319433Medicaid
TN33054611Medicare PIN