Provider Demographics
NPI:1891791026
Name:MILLER, MONICA A (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:A
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 1:2200 PHILADELPHIA DR
Mailing Address - Street 2:STE 441
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1840
Mailing Address - Country:US
Mailing Address - Phone:937-734-4690
Mailing Address - Fax:937-567-4186
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:STE 441
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-734-4690
Practice Address - Fax:937-567-4186
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075412207Q00000X
OH35.075412208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00403827OtherRAILROAD MEDICARE
KYTP474OtherLICENSE
OH2150194Medicaid
OHH014030Medicare PIN
OH2150194Medicaid
KY0364982Medicare PIN