Provider Demographics
NPI:1548240468
Name:MILLER, DYLAN V (MD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:V
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 1:5252 S INTERMOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5700
Mailing Address - Country:US
Mailing Address - Phone:801-507-2150
Mailing Address - Fax:801-507-2311
Practice Address - Street 1:5252 S INTERMOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-507-2150
Practice Address - Fax:801-507-2311
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7192380-1205207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94002359Medicaid
MN819638900Medicaid
ID808386400Medicaid
OK200245740AMedicaid
OK200245740AMedicaid
UT000066819Medicare PIN
H41162Medicare UPIN
MN220000843Medicare ID - Type Unspecified