Provider Demographics
NPI:1972569960
Name:MILLER, AMY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:312 E HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1128
Mailing Address - Country:US
Mailing Address - Phone:989-345-9774
Mailing Address - Fax:989-345-9778
Practice Address - Street 1:111 S 3RD ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1331
Practice Address - Country:US
Practice Address - Phone:989-345-9774
Practice Address - Fax:989-345-9778
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002109213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M2298004Medicare PIN
MIV07455Medicare UPIN