Provider Demographics
NPI:1750367009
Name:MILLER, JOHN D (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26750 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1211
Mailing Address - Country:US
Mailing Address - Phone:248-348-5300
Mailing Address - Fax:248-348-5410
Practice Address - Street 1:26750 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1211
Practice Address - Country:US
Practice Address - Phone:248-348-5300
Practice Address - Fax:248-348-5410
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM002024213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI136049OtherCARE CHOICES
MIU85106OtherHAP
MI480F372470OtherBLUE CROSS BLUE SHIELD
MI4454647Medicaid
MI75232394OtherAETNA
MI14629OtherMCARE
MI0F37247007Medicare ID - Type Unspecified
MI4454647Medicaid