Provider Demographics
NPI:1891770665
Name:MILLER, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
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 1:3958 LEAP RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-3107
Mailing Address - Country:US
Mailing Address - Phone:614-876-7330
Mailing Address - Fax:614-876-6974
Practice Address - Street 1:3958 LEAP RD STE 101
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-3107
Practice Address - Country:US
Practice Address - Phone:614-876-7330
Practice Address - Fax:614-876-6974
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2611730Medicaid
OHMI4167471Medicare ID - Type Unspecified