Provider Demographics
NPI:1649523705
Name:MILLER, MITCHELL J (HIS)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-7709
Mailing Address - Country:US
Mailing Address - Phone:608-781-8576
Mailing Address - Fax:
Practice Address - Street 1:1840 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-7709
Practice Address - Country:US
Practice Address - Phone:608-781-8576
Practice Address - Fax:608-781-8546
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2722237700000X
WI1364237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist