Provider Demographics
NPI:1801853791
Name:MILLER, MICHAEL T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231-1368
Mailing Address - Country:US
Mailing Address - Phone:716-859-2954
Mailing Address - Fax:716-859-2962
Practice Address - Street 1:3 GATES CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1120
Practice Address - Country:US
Practice Address - Phone:716-859-2954
Practice Address - Fax:716-859-2962
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1645832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000911511011OtherBLUE SHIELD WNY
101121FFOtherPREFERRED CARE
NY16485378BOtherWORKERS COMPENSATION
P020164583OtherBLUE SHIELD OF ROCHESTER
00025553402OtherUNIVERA
0141997OtherGHI
1693148OtherINDEPENDENT HEALTH
00025553404OtherUNIVERA
040426003057OtherFIDELIS
P010164583OtherBLUE CHOICE
000911511014OtherBLUE SHIELD WNY
NY01033590Medicaid
4195937OtherGHI
P00005726OtherRR MEDICARE
NYB98180Medicare UPIN
00025553404OtherUNIVERA
000911511011OtherBLUE SHIELD WNY
NY01033590Medicaid