Provider Demographics
NPI:1720016215
Name:MILLER, JOEL A (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 606
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-356-8610
Mailing Address - Fax:248-356-6473
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 606
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-356-8610
Practice Address - Fax:248-356-6473
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043653207WX0107X
MI43010 43653207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2598450Medicaid
MIB46873Medicare UPIN
MI2598450Medicaid