Provider Demographics
NPI:1881808061
Name:MILLER, JACOB BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:BENJAMIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 412431
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-2431
Mailing Address - Country:US
Mailing Address - Phone:913-647-4100
Mailing Address - Fax:913-258-2509
Practice Address - Street 1:100 NE SAINT LUKES BLVD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6000
Practice Address - Country:US
Practice Address - Phone:816-347-5097
Practice Address - Fax:816-347-5045
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011012600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881808061Medicaid
MO207086307Medicaid
MOP01085334OtherRAILROAD
MO46511019OtherBCBS KC