MEDICARE: MICHAEL L MILLER DO

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	2085R0001X	Radiation Oncology Physician	0102201681	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00291447	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	96553	OTHER	VA	OPTIMA

General Provider Information

NPI Number	:	1548267917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL L MILLER DO

Provider Business Mailing Address
First Line	:	5900 LAKE WRIGHT DR
Second Line	:	SUITE 300
City	:	NORFOLK
State	:	VA
Zip	:	23502-1871
Country	:	US
Telephone Number	:	757-213-5700
Fax Number	:	757-213-5701

Provider Business Practice Location Address
First Line	:	3000 COLISEUM DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-5963
Country	:	US
Telephone Number	:	757-827-2430
Fax Number	:	757-827-2432

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	09/22/2014

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