MEDICARE: JEFFREY R MILLER MD

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	2085R0202X	Diagnostic Radiology Physician	32709	KY
2	2085R0204X	Vascular & Interventional Radiology Physician	01052478A	IN
3	2085R0202X	Diagnostic Radiology Physician	01052478A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00476263	OTHER	KY	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000546001	OTHER	KY	ANTHEM BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134114960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY R MILLER MD

Provider Business Mailing Address
First Line	:	PO BOX 436
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42419-0436
Country	:	US
Telephone Number	:	812-471-1591
Fax Number	:	812-471-6650

Provider Business Practice Location Address
First Line	:	1305 N ELM ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2783
Country	:	US
Telephone Number	:	812-485-4415
Fax Number	:	812-471-6650

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	09/28/2020

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Directions to “ JEFFREY R MILLER MD” Practice Location

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