Provider Demographics
NPI:1245327097
Name:MILLER, KELLI M (MD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950171
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0171
Mailing Address - Country:US
Mailing Address - Phone:502-891-8700
Mailing Address - Fax:502-891-8709
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-891-8700
Practice Address - Fax:502-891-8709
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34963207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64106669Medicaid
KY0567212Medicare ID - Type Unspecified
KYH67808Medicare UPIN