Provider Demographics
NPI:1902850860
Name:MILLER, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MILLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1600 SAINT JOHNS BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1183
Mailing Address - Country:US
Mailing Address - Phone:651-779-9322
Mailing Address - Fax:651-779-9325
Practice Address - Street 1:1600 SAINT JOHNS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1183
Practice Address - Country:US
Practice Address - Phone:651-779-9322
Practice Address - Fax:651-779-9325
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-11-29
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Provider Licenses
StateLicense IDTaxonomies
MN45581207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500040800Medicaid