Provider Demographics
NPI:1740591395
Name:NOVI VEIN - TROY, PC
Entity Type:Organization
Organization Name:NOVI VEIN - TROY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-344-9110
Mailing Address - Street 1:230 W MAPLE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5435
Mailing Address - Country:US
Mailing Address - Phone:248-344-9110
Mailing Address - Fax:248-344-9111
Practice Address - Street 1:230 W MAPLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5435
Practice Address - Country:US
Practice Address - Phone:248-344-9110
Practice Address - Fax:248-344-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054286202K00000X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF66032Medicare UPIN