Provider Demographics
NPI:1679514673
Name:MILLER, KIRT THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:KIRT
Middle Name:THOMAS
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 US ROUTE 60 E
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2004
Mailing Address - Country:US
Mailing Address - Phone:304-528-4610
Mailing Address - Fax:304-522-7610
Practice Address - Street 1:5170 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2004
Practice Address - Country:US
Practice Address - Phone:304-528-4610
Practice Address - Fax:304-522-7610
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00348213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2283694Medicaid
KY8000034Medicaid
480034210OtherRAILROAD MEDICARE
WV2103013000Medicaid
KY8000034Medicaid