Provider Demographics
NPI:1801620109
Name:MILLER, DAVID ADAM
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ADAM
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2535
Mailing Address - Country:US
Mailing Address - Phone:216-403-4495
Mailing Address - Fax:
Practice Address - Street 1:1129 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2535
Practice Address - Country:US
Practice Address - Phone:216-403-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider