MEDICARE: KENNETH JOSEPH MILLER M.D.

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	2084P0800X	Psychiatry Physician	35.049517	OH
2	2084P0800X	Psychiatry Physician	C41166	CA
3	2084P0800X	Psychiatry Physician	0101253992	VA
4	2084P0800X	Psychiatry Physician	MD33125	SC

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

General Provider Information

NPI Number	:	1225066418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH JOSEPH MILLER M.D.

Provider Business Mailing Address
First Line	:	32 BAY FRONT PL
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23664-1791
Country	:	US
Telephone Number	:	614-832-8392
Fax Number	:	888-383-3873

Provider Business Practice Location Address
First Line	:	32 BAY FRONT PL
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23664-1791
Country	:	US
Telephone Number	:	614-832-8392
Fax Number	:	888-383-3873

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	12/28/2015

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