Provider Demographics
NPI:1831117589
Name:MILLER, SUSAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:DESK A10
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-3420
Mailing Address - Country:US
Mailing Address - Phone:216-444-6987
Mailing Address - Fax:
Practice Address - Street 1:2049 E 100TH ST
Practice Address - Street 2:DESK A10
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-2203
Practice Address - Country:US
Practice Address - Phone:216-444-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350595402085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0909799Medicaid
OH300037098OtherINDIVIDUAL RR MEDICARE #
OH34165342900OtherGROUP WORKERS COMP#
OH0798445Medicaid
OH341653429OtherGROUP TAX ID#
OH341653429006OtherGRP MEDICAL MUTUAL OF OH.
OH000000028415OtherGROUP ANTHEM ID #
OH000000028694OtherINDIVIDUAL ANTHEM ID #
OHCC0299OtherGROUP RR MEDICARE #
OHCC0299OtherGROUP RR MEDICARE #
OHF41634Medicare UPIN
OH0909799Medicaid