Provider Demographics
NPI:1811911605
Name:MILLER, GLENN ALAN (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:ALAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G.
Other - Middle Name:ALAN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9342 CEDAR CENTER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4522
Practice Address - Country:US
Practice Address - Phone:502-239-3228
Practice Address - Fax:502-231-2517
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY107573OtherSIHO NHC
KY000000627187OtherANTHEM NHC
2538886OtherCIGNA
KYP00761140Medicare PIN
KY000000627187OtherANTHEM NHC