Healthcare Provider Details

I. General information

NPI: 1124355219
Provider Name (Legal Business Name): GEORGE E. MILLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL VILLAGE DR SUITE 338
EDGEWOOD KY
41017-5401
US

IV. Provider business mailing address

3747 W FORK RD
CINCINNATI OH
45247-7548
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-5035
  • Fax: 859-341-9080
Mailing address:
  • Phone: 513-961-4335
  • Fax: 513-961-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17684
License Number StateKY

VIII. Authorized Official

Name: CONNIE KNOEBEL
Title or Position: BILLING MANAGER
Credential:
Phone: 513-961-4335