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NPI Code Detail

MEDICARE: DR. THEODORE JOSEPH MILLER IV MD

MEDICARE: DR. THEODORE JOSEPH MILLER IV 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
1208000000XPediatrics Physician57.260147OH
2390200000XStudent in an Organized Health Care Education/Training Program57.260147OH
3207R00000XInternal Medicine Physician57.260147OH

General Provider Information

NPI Number : 1962341792
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THEODORE JOSEPH MILLER IV MD
Provider Business Mailing Address
First Line : 700 CHILDRENS DR # ED277
Second Line :
City : COLUMBUS
State : OH
Zip : 43205-2664
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1405 S HIGH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1043
Country : US
Telephone Number : 614-355-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2026
Last Update Date : 06/13/2026

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