Provider Demographics
NPI:1861463986
Name:MILLER, KEITH N (DO)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:N
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8166 MARKET ST
Mailing Address - Street 2:PATHOLOGYCONSULTANTS-CREDENTIALS
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6262
Mailing Address - Country:US
Mailing Address - Phone:330-953-3242
Mailing Address - Fax:330-953-3243
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:PATHOLOGY CONSULTANTS-CREDENTIALING
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:330-480-3768
Practice Address - Fax:330-480-2062
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3925-M207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0885476Medicaid
OH0885476Medicaid