Provider Demographics
NPI:1518968155
Name:MILLER, OTIS E II
Entity Type:Individual
Prefix:
First Name:OTIS
Middle Name:E
Last Name:MILLER
Suffix:II
Gender:M
Credentials:
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 411039
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1039
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-676-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28117207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26047069OtherBCBS OF KC MO
P00183119OtherRR MEDICARE GROUP DC6712
01674018OtherBCBS KCMO GROUP 01674018
KS26047049OtherBCBS KC MO
KS100345990CMedicaid
MO206039505Medicaid
KS100345990AMedicaid
930128507OtherRR MEDICARE GROUP CC8899
MO26047069OtherBCBS OF KC MO
MO206039505Medicaid
KS26047049OtherBCBS KC MO