MEDICARE: RYAN JACOB MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	4301513462	MI

General Provider Information

NPI Number	:	1033869292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN JACOB MILLER

Provider Business Mailing Address
First Line	:	850 W BARAGA AVE
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-4550
Country	:	US
Telephone Number	:	906-449-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 W BARAGA AVE
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-4550
Country	:	US
Telephone Number	:	906-449-3560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	05/09/2026

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