Healthcare Provider Details

I. General information

NPI: 1427269232
Provider Name (Legal Business Name): DANIEL JAIRO MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD HENRY FORD HOSPITAL
DETROIT MI
48202
US

IV. Provider business mailing address

1021 HARVARD RD
GROSSE POINTE PARK MI
48230-1455
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-3700
  • Fax:
Mailing address:
  • Phone: 313-622-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301087971
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number4301087971
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: