MEDICARE: DR. BRUCE KENNETH 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	207RC0000X	Cardiovascular Disease Physician	4301047312	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700F37550	OTHER	MI	BCBSM
2	700F37550	OTHER	MI	BCN
3	38-3468933	OTHER	MI	COMMERCIAL
4	B46985	OTHER	MI	HAP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	C5244	OTHER	MI	MCARE

General Provider Information

NPI Number	:	1689638694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE KENNETH MILLER M.D.

Provider Business Mailing Address
First Line	:	42557 WOODWARD AVE STE 130
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5206
Country	:	US
Telephone Number	:	248-322-3088
Fax Number	:	248-322-4175

Provider Business Practice Location Address
First Line	:	42557 WOODWARD AVE STE 210
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5206
Country	:	US
Telephone Number	:	248-253-1608
Fax Number	:	248-253-1660

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/03/2014

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Directions to “ DR. BRUCE KENNETH MILLER M.D.” Practice Location

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