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NPI Code Detail

MEDICARE: MICHAEL MILLER ATC, AT

MEDICARE: MICHAEL MILLER ATC, AT
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
12255A2300XAthletic Trainer2601000578MI

General Provider Information

NPI Number : 1457769341
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL MILLER ATC, AT
Provider Business Mailing Address
First Line : 4001 W MCNICHOLS RD
Second Line :
City : DETROIT
State : MI
Zip : 48221-3038
Country : US
Telephone Number : 313-993-1740
Fax Number : 313-993-1741
Provider Business Practice Location Address
First Line : 4001 W MCNICHOLS RD
Second Line :
City : DETROIT
State : MI
Zip : 48221-3038
Country : US
Telephone Number : 313-993-1740
Fax Number : 313-993-1741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2014
Last Update Date : 07/24/2014

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