Healthcare Provider Details

I. General information

NPI: 1124601869
Provider Name (Legal Business Name): MATTHEW STEVEN MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR SPC 5328
ANN ARBOR MI
48109-5328
US

IV. Provider business mailing address

2644 TRAVER BLVD
ANN ARBOR MI
48105-1297
US

V. Phone/Fax

Practice location:
  • Phone: 801-699-7881
  • Fax:
Mailing address:
  • Phone: 801-699-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: