Provider Demographics
NPI:1922091073
Name:MILLER, TIM ALAN (MD)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:ALAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 REMITTANCE DR DEPT 8310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-8310
Mailing Address - Country:US
Mailing Address - Phone:412-230-8200
Mailing Address - Fax:412-202-8638
Practice Address - Street 1:1 NOLTE DR
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7111
Practice Address - Country:US
Practice Address - Phone:412-230-8200
Practice Address - Fax:412-202-8638
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043515E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011649390006Medicaid
IA0120725Medicaid
IA50860OtherBLUE CROSS BLUE SHIELD IA
IAE52782Medicare UPIN
IA50860OtherBLUE CROSS BLUE SHIELD IA