Provider Demographics
NPI:1831175215
Name:MILLER, KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1800
Mailing Address - Country:US
Mailing Address - Phone:740-454-4651
Mailing Address - Fax:740-454-4653
Practice Address - Street 1:751 FOREST AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2868
Practice Address - Country:US
Practice Address - Phone:740-454-8502
Practice Address - Fax:740-454-8641
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056504M208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0692148Medicaid
OH000000018874OtherANTHEM PIN
OH000000177615OtherUNISON PIN
OH311413469034OtherCARESOURCE PIN
OH0989499OtherGROUP MEDICAID
OH1204543OtherUHC PIN
OH311413469034OtherCARESOURCE PIN
OH0989499OtherGROUP MEDICAID
C78431Medicare UPIN