Provider Demographics
NPI:1760406243
Name:MILLER, MICHAEL STEPHEN (PHD MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3455 WILKENS AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229
Mailing Address - Country:US
Mailing Address - Phone:410-525-0508
Mailing Address - Fax:410-525-0509
Practice Address - Street 1:3455 WILKENS AVE
Practice Address - Street 2:STE 104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-525-0508
Practice Address - Fax:410-525-0509
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD005462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E00546Medicare UPIN
6259Medicare ID - Type Unspecified