Provider Demographics
NPI:1982686119
Name:MILLER, RUSSELL W (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:44199 DEQUINDRE RD
Mailing Address - Street 2:STE 250
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1128
Mailing Address - Country:US
Mailing Address - Phone:248-879-8441
Mailing Address - Fax:248-879-6841
Practice Address - Street 1:44199 DEQUINDRE RD
Practice Address - Street 2:STE 250
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-879-8441
Practice Address - Fax:248-879-6841
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301035118207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1487223Medicaid
OP00270Medicare ID - Type Unspecified
MI1487223Medicaid