Provider Demographics
NPI:1821065145
Name:MILLER, DUANE (MD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:MILLER
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 1:7455 N 95TH AVE APT 1022
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-1352
Mailing Address - Country:US
Mailing Address - Phone:574-364-5875
Mailing Address - Fax:
Practice Address - Street 1:7455 N 95TH AVE APT 1022
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-1352
Practice Address - Country:US
Practice Address - Phone:574-364-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54412207PE0004X
IN01027831207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN010029956OtherRAIL ROAD MEDICARE
IN100145690Medicaid
MI102669220Medicaid
IN000000082220OtherANTHEM