Provider Demographics
NPI:1942272596
Name:MILLER, RICHARD MERTON (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MERTON
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2222 CHERRY ST
Practice Address - Street 2:SUITE M900
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2673
Practice Address - Country:US
Practice Address - Phone:419-251-6784
Practice Address - Fax:419-251-6787
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002592A207X00000X
OH34007276M207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200046241OtherRAILROAD MEDICARE
IN200440250Medicaid
OH2210093Medicaid
INH19699Medicare UPIN
OHMI4031793Medicare PIN
OHMI4031793Medicare PIN