Provider Demographics
NPI:1790826089
Name:MILER, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MILER
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 1:2700 WESTCHESTER AVE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2547
Mailing Address - Country:US
Mailing Address - Phone:914-934-3360
Mailing Address - Fax:
Practice Address - Street 1:2700 WESTCHESTER AVE
Practice Address - Street 2:SUITE #105
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2547
Practice Address - Country:US
Practice Address - Phone:914-934-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132790-7174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132790-7OtherWORKERS COMPENSATION
NY25A972OtherBLUE CROSS
NY132790-7OtherWORKERS COMPENSATION
NY25A971Medicare UPIN