Provider Demographics
NPI:1619045671
Name:MILLER, EDWARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
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 1:2434 APACHE CT
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-4352
Mailing Address - Country:US
Mailing Address - Phone:608-359-9061
Mailing Address - Fax:
Practice Address - Street 1:2434 APACHE CT
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-4352
Practice Address - Country:US
Practice Address - Phone:608-359-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21506207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30170800Medicaid
B55114Medicare UPIN
WI541760024Medicare PIN