Provider Demographics
NPI:1922189760
Name:MILLER, JOHN P (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1866
Mailing Address - Country:US
Mailing Address - Phone:716-373-3338
Mailing Address - Fax:716-373-4825
Practice Address - Street 1:2646 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1866
Practice Address - Country:US
Practice Address - Phone:716-373-3338
Practice Address - Fax:716-373-4825
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003364-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN003364-1OtherNYS PODIATRY LICENSE #
NYP033648OtherWORKMEN'S COMPENSATION
NY00010256601OtherCHOICE CARE
NY000508537007OtherBC/BS OF WNY
NY00716752Medicaid
NY10400030OtherNYS MEDICAID HMO
NY16-1183452OtherEMPLOYER IDENTIFICATION #
NY00508537007OtherCOMMUNITY BLUE (BC/BS WNY
NY0010256601OtherUNIVERA
NYAM1637872OtherDEA #
NYT02043Medicare UPIN
NY00716752Medicaid