Provider Demographics
NPI:1295334746
Name:MILLER, JOEL ALLEN (PA)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ALLEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 NORWICH DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-5332
Mailing Address - Country:US
Mailing Address - Phone:920-288-7413
Mailing Address - Fax:
Practice Address - Street 1:2125 NORWICH DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-5332
Practice Address - Country:US
Practice Address - Phone:920-288-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center