Healthcare Provider Details

I. General information

NPI: 1831728443
Provider Name (Legal Business Name): JEREMY BRIAN MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 NEWBURG RD STE 150
LOUISVILLE KY
40218-2497
US

IV. Provider business mailing address

3430 NEWBURG RD STE 150
LOUISVILLE KY
40218-2497
US

V. Phone/Fax

Practice location:
  • Phone: 502-559-5864
  • Fax:
Mailing address:
  • Phone: 502-559-5864
  • Fax: 502-459-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberTP248
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: