Provider Demographics
NPI:1689638694
Name:MILLER, BRUCE KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
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 1:42557 WOODWARD AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5206
Mailing Address - Country:US
Mailing Address - Phone:248-322-3088
Mailing Address - Fax:248-322-4175
Practice Address - Street 1:42557 WOODWARD AVE STE 210
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5206
Practice Address - Country:US
Practice Address - Phone:248-253-1608
Practice Address - Fax:248-253-1660
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047312207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F37550OtherBCBSM
MI700F37550OtherBCN
MI38-3468933OtherCOMMERCIAL
MIB46985OtherHAP
MI4696880-10Medicaid
MIC5244OtherMCARE
MI38-3468933OtherCOMMERCIAL
MIC5244OtherMCARE