Provider Demographics
NPI:1710902267
Name:BRUCE D. MILLER D.O.P.C.
Entity Type:Organization
Organization Name:BRUCE D. MILLER D.O.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DOPC
Authorized Official - Phone:586-466-5273
Mailing Address - Street 1:PO BOX 46027
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48046-6027
Mailing Address - Country:US
Mailing Address - Phone:586-466-5273
Mailing Address - Fax:586-466-5393
Practice Address - Street 1:26755 BALLARD RD.
Practice Address - Street 2:
Practice Address - City:HARRISON TWP.
Practice Address - State:MI
Practice Address - Zip Code:48045-2458
Practice Address - Country:US
Practice Address - Phone:586-466-5273
Practice Address - Fax:586-466-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005712207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1016210Medicaid
MIE25566Medicare UPIN
MI1016210Medicaid