Healthcare Provider Details

I. General information

NPI: 1063642205
Provider Name (Legal Business Name): JOHN KEVIN MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 21ST ST
ASHLAND KY
41101-7726
US

IV. Provider business mailing address

330 21ST ST
ASHLAND KY
41101-7726
US

V. Phone/Fax

Practice location:
  • Phone: 833-409-3747
  • Fax:
Mailing address:
  • Phone: 606-325-6493
  • Fax: 606-324-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.094459
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number46681
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: