Provider Demographics
NPI:1740637446
Name:MILLER, JOHN MARK (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3131 NEWMARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5400
Mailing Address - Country:US
Mailing Address - Phone:937-436-4658
Mailing Address - Fax:937-436-4984
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-395-8166
Practice Address - Fax:937-395-8347
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013250207P00000X, 390200000X
NC2021-02402207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34.013250OtherOHIO STATE MEDICAL BOARD