Provider Demographics
NPI:1841649589
Name:MILLER, KENNETH JOHN (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOHN
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 1:4098 SCARLET IRIS PL
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9412
Mailing Address - Country:US
Mailing Address - Phone:407-765-3155
Mailing Address - Fax:
Practice Address - Street 1:4098 SCARLET IRIS PL
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9412
Practice Address - Country:US
Practice Address - Phone:407-765-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL039057207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology