Provider Demographics
NPI:1750367959
Name:MILLER, GARY A (DPM)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 167875
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-7875
Mailing Address - Country:US
Mailing Address - Phone:419-474-7700
Mailing Address - Fax:419-474-0896
Practice Address - Street 1:3106 TREMAINSVILLE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613
Practice Address - Country:US
Practice Address - Phone:419-474-7700
Practice Address - Fax:419-474-0896
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002438213EP1101X
OH36002438213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0730267Medicaid
OHMI0631832Medicare ID - Type UnspecifiedPODIATRY
OH0730267Medicaid