Healthcare Provider Details

I. General information

NPI: 1104514082
Provider Name (Legal Business Name): HENRY MILLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 S STATE ST # 3007
DOVER DE
19901-6925
US

IV. Provider business mailing address

640 S STATE ST # 3007
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-725-3200
  • Fax:
Mailing address:
  • Phone: 540-522-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC7-0018189
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: