Provider Demographics
NPI:1982851549
Name:MILLER, KEVIN MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1101 B GALE WILSON BLVD
Mailing Address - Street 2:SUITE 101C
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3700
Mailing Address - Country:US
Mailing Address - Phone:707-646-4644
Mailing Address - Fax:707-646-4645
Practice Address - Street 1:2500 HILBORN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1097
Practice Address - Country:US
Practice Address - Phone:707-646-5599
Practice Address - Fax:707-624-7301
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4801213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery