Provider Demographics
NPI:1558478370
Name:MILLERMAIER, JANET MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MARIE
Last Name:MILLERMAIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN STREET NE MC 845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:25 CONRAN DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49504-1366
Practice Address - Country:US
Practice Address - Phone:616-267-7860
Practice Address - Fax:616-267-7861
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55461-20207Q00000X
MI4301066454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95709Medicare UPIN
WI075100131Medicare Oscar/Certification
WIP00962536Medicare Oscar/Certification
WI073550100Medicare Oscar/Certification