Provider Demographics
NPI:1598961310
Name:MILLER, CORTLAND KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CORTLAND
Middle Name:KENNETH
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 1:1120 RAINTREE CIRCLE, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5257
Mailing Address - Country:US
Mailing Address - Phone:817-442-9300
Mailing Address - Fax:844-358-4178
Practice Address - Street 1:1120 RAINTREE CIRCLE, SUITE 110
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5257
Practice Address - Country:US
Practice Address - Phone:817-442-9300
Practice Address - Fax:844-358-4178
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059561208100000X
TXN0278208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX471837ZSTXMedicare PIN
TX471837ZSTTMedicare PIN