Provider Demographics
NPI:1508953373
Name:MILLER, SANFORD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:ALLEN
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 1:5 SEVERANCE CIRCLE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118
Mailing Address - Country:US
Mailing Address - Phone:216-291-4891
Mailing Address - Fax:216-291-5623
Practice Address - Street 1:5 SEVERANCE CIRCLE
Practice Address - Street 2:SUITE 510
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118
Practice Address - Country:US
Practice Address - Phone:216-291-4891
Practice Address - Fax:216-291-5623
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031853174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0305173Medicaid
OHMI042287Medicare PIN
OH0305173Medicaid