Provider Demographics
NPI:1457345175
Name:MILLER, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 9120
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02027-9120
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-278-5667
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
760135OtherTUFTS COMMONWEALTH PPO
0440324OtherUNITED HEALTHCARE (PPO)
760135OtherTUFTS
760135OtherTUFTS BENEFIT ADMIN.
J09491OtherBLUE SHIELD-INDEMNITY
6747246OtherHEALTHSOURCE MA
J09491OtherHMO BLUE/BLUE CHOICE
61402OtherHARVARD PILGRIM POS
61402OtherHARVARD / PILGRIM
6747246OtherCIGNA HEALTH CARE
760135OtherTUFTS TOTAL HEALTH PLAN
E38734OtherFIRST SENIORITY
J09491OtherBS-BLUE CARE ELECT
0016049OtherNEIGHBORHOOD HEALTH PLAN
110132397OtherRAILROAD MEDICARE
27575OtherCHILDREN'S MED. SECURITY
3059791OtherMAS HEALTH
61402OtherHARVARD PILGRIM PPO
E38734OtherFIRST SENIORITY
J09491Medicare ID - Type Unspecified