Provider Demographics
NPI:1891389177
Name:MILLER, DAVID JUNIOR JR
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JUNIOR
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 S PACKARD AVE
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-2311
Mailing Address - Country:US
Mailing Address - Phone:810-288-2226
Mailing Address - Fax:
Practice Address - Street 1:1173 S PACKARD AVE
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-2311
Practice Address - Country:US
Practice Address - Phone:810-288-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker