Provider Demographics
NPI:1962464768
Name:MILLER, RICHARD DEAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEAN
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 1:943 N ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9795
Mailing Address - Country:US
Mailing Address - Phone:316-733-4747
Mailing Address - Fax:316-733-5253
Practice Address - Street 1:943 N ANDOVER RD
Practice Address - Street 2:SUITE G
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9795
Practice Address - Country:US
Practice Address - Phone:316-733-4747
Practice Address - Fax:316-733-5253
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27968208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100337800AMedicaid
KS100337800AMedicaid