Provider Demographics
NPI:1922008754
Name:MILLER, BRET HUNTER (MD)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:HUNTER
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 1:510 LINCOLN DRIVE
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-6334
Mailing Address - Country:US
Mailing Address - Phone:618-997-6800
Mailing Address - Fax:616-998-9635
Practice Address - Street 1:510 LINCOLN DRIVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-6334
Practice Address - Country:US
Practice Address - Phone:618-997-6800
Practice Address - Fax:618-998-9635
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2608207X00000X, 207XS0114X, 207XX0005X
IL036.124631207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119479100OtherFIRSTCARE
TX8A0860OtherBLUE CROSS BLUE SHIELD
TX119479100OtherSOUTHWEST LIFE & HEALTH
TXA002OtherTRICARE
TX1187270-01Medicaid
TX010064217OtherMEDICARE RAILROAD
TX119060OtherSUPERIOR HEALTH PLAN
TX178337000OtherUS DEPARTMENT OF LABOR
TX178337000OtherU.S. DEPARTMENT OF LABOR
TX8597K0Medicare ID - Type Unspecified
TX178337000OtherU.S. DEPARTMENT OF LABOR