Provider Demographics
NPI:1801875877
Name:MILLER, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1520 S MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2698
Mailing Address - Country:US
Mailing Address - Phone:937-208-7240
Mailing Address - Fax:937-208-7242
Practice Address - Street 1:1520 S MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2698
Practice Address - Country:US
Practice Address - Phone:937-208-7240
Practice Address - Fax:937-208-7242
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35067912208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187128Medicaid
OH4018932Medicare PIN
OH4018933Medicare PIN
G53912Medicare UPIN