Provider Demographics
NPI:1710902804
Name:MILLER, MICHAEL M (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
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 1:6729 DEERFOOT PKWY
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3093
Mailing Address - Country:US
Mailing Address - Phone:205-681-5377
Mailing Address - Fax:205-681-6276
Practice Address - Street 1:6729 DEERFOOT PKWY
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-3093
Practice Address - Country:US
Practice Address - Phone:205-681-5377
Practice Address - Fax:205-681-6276
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22920208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5076237OtherCIGNA
AL2095296OtherUNITED HEALTH CARE
AL51506480OtherBC/BS
AL51502150OtherBC/BS
AL51506480OtherBC/BS