Provider Demographics
NPI:1891985263
Name:MILLER, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
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:P.O. BOX 241587
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-1587
Mailing Address - Country:US
Mailing Address - Phone:334-280-1500
Mailing Address - Fax:334-280-1600
Practice Address - Street 1:273 WINTON M BLOUNT LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3507
Practice Address - Country:US
Practice Address - Phone:334-280-1500
Practice Address - Fax:334-280-1600
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29409207RC0000X, 207RI0011X, 207R00000X, 207UN0901X
TN55902207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51048473OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL51103115OtherBLUE CROSS
LA1091103Medicaid
AL51048470OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL51048472OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL1891985263Medicaid
AL51048749OtherBLUE CROSS
AL51048751OtherBLUE CROSS
AL102I065035OtherMEDICARE PTAN
AL51048750OtherBLUE CROSS
AL51048471OtherBLUE CROSS BLUE SHIELD OF ALABAMA