Provider Demographics
NPI:1609862259
Name:MILLER, DENISE K (DO)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
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 57
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43845-0057
Mailing Address - Country:US
Mailing Address - Phone:740-545-7919
Mailing Address - Fax:740-545-0856
Practice Address - Street 1:6307 E STATE RD
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-9063
Practice Address - Country:US
Practice Address - Phone:740-498-5515
Practice Address - Fax:740-498-5567
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2576510Medicaid
OHI31493Medicare UPIN
OH2576510Medicaid