Provider Demographics
NPI:1700039690
Name:MILLER, LAURA ELLEN (DO)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ELLEN
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 1:285 E STATE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4322
Mailing Address - Country:US
Mailing Address - Phone:614-460-6100
Mailing Address - Fax:614-460-6500
Practice Address - Street 1:285 E. STATE ST SUITE 150
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-460-6100
Practice Address - Fax:614-460-6500
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.002859207R00000X
OH34.010014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3111617Medicaid