Provider Demographics
NPI:1679579551
Name:MILLER, KEVIN B (MD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:B
Last Name:MILLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:500 ELDORADO BLVD
Mailing Address - Street 2:STE 6250
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:1960 OGDEN ST
Practice Address - Street 2:STE 540
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3666
Practice Address - Country:US
Practice Address - Phone:303-318-2440
Practice Address - Fax:303-318-2485
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-01-30
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Provider Licenses
StateLicense IDTaxonomies
CO36350208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01363506Medicaid
COCOA103380Medicare PIN
CO01363506Medicaid