MEDICARE: KURESTIN JADE 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	207R00000X	Internal Medicine Physician	MD494724	PA
2	208000000X	Pediatrics Physician	MD494724	PA

General Provider Information

NPI Number	:	1700536927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURESTIN JADE MILLER MD

Provider Business Mailing Address
First Line	:	PO BOX 500
Second Line	:
City	:	INTERCOURSE
State	:	PA
Zip	:	17534-0500
Country	:	US
Telephone Number	:	717-687-9407
Fax Number	:	717-687-9237

Provider Business Practice Location Address
First Line	:	20 COMMUNITY LN
Second Line	:
City	:	GORDONVILLE
State	:	PA
Zip	:	17529-9707
Country	:	US
Telephone Number	:	717-687-9407
Fax Number	:	717-687-9237

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

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	06/10/2026

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