Provider Demographics
NPI:1710166061
Name:HURON VALLEY OBSTETRICS & GYNECOLOGY, PC
Entity Type:Organization
Organization Name:HURON VALLEY OBSTETRICS & GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-360-1770
Mailing Address - Street 1:8906 COMMERCE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4484
Mailing Address - Country:US
Mailing Address - Phone:248-360-1770
Mailing Address - Fax:248-360-1950
Practice Address - Street 1:8906 COMMERCE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4484
Practice Address - Country:US
Practice Address - Phone:248-360-1770
Practice Address - Fax:248-360-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM007511207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26122OtherHAP
MI1676015Medicaid
MI128904OtherCARE CHOICES
MI1656336375OtherBCBS OF MI
MIE26122Medicare UPIN
MI1676015Medicaid