Healthcare Provider Details

I. General information

NPI: 1790777241
Provider Name (Legal Business Name): MICHAEL J MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10095 INVESTMENT WAY
FLORENCE KY
41042-4798
US

IV. Provider business mailing address

10095 INVESTMENT WAY
FLORENCE KY
41042-4798
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-9070
  • Fax: 859-301-9075
Mailing address:
  • Phone: 859-301-9070
  • Fax: 859-301-9075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24910
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35051327
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number24910
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: