Provider Demographics
NPI:1912788761
Name:MILLER, DANIEL EVERETTE JR (RPA CBRPA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EVERETTE
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:RPA CBRPA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:155 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:CLARKLAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49234-9622
Mailing Address - Country:US
Mailing Address - Phone:517-581-3183
Mailing Address - Fax:
Practice Address - Street 1:155 PENNY LN
Practice Address - Street 2:
Practice Address - City:CLARKLAKE
Practice Address - State:MI
Practice Address - Zip Code:49234-9622
Practice Address - Country:US
Practice Address - Phone:517-581-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07KS1320243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant