Provider Demographics
NPI:1710982434
Name:MILLER, STACEY LYNNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LYNNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44250 GARFIELD RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1150
Mailing Address - Country:US
Mailing Address - Phone:586-228-2255
Mailing Address - Fax:586-228-2740
Practice Address - Street 1:44250 GARFIELD RD
Practice Address - Street 2:STE 160
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1150
Practice Address - Country:US
Practice Address - Phone:586-228-2255
Practice Address - Fax:586-228-2740
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISM001761213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104531OtherGREAT LAKES HEALTH PLAN
MI4616763Medicaid
MI4855050800OtherBLUE CROSS BLUE SHIELD MI
MI4855050800OtherBLUE CARE NETWORK
MI9102424001OtherCIGNA
MIU71952OtherHEALTH ALLIANCE PLAN
MI10113130003OtherWELLNESS
MI4616763OtherMOLINA
MI17303OtherMCARE
MI7538001OtherAETNA
MI126745OtherPREFERRED/CARE CHOICES
MIP00140080OtherRAILROAD MEDICARE
MI17303OtherMCARE
MI9102424001OtherCIGNA
MI4616763Medicaid
MI0N94990Medicare PIN