Healthcare Provider Details

I. General information

NPI: 1164405536
Provider Name (Legal Business Name): RONALD V MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30055 NORTHWESTERN HWY STE 220
FARMINGTON HILLS MI
48334-3230
US

IV. Provider business mailing address

30055 NORTHWESTERN HWY STE 220
FARMINGTON HILLS MI
48334-3230
US

V. Phone/Fax

Practice location:
  • Phone: 248-865-9898
  • Fax: 248-865-9423
Mailing address:
  • Phone: 248-865-9898
  • Fax: 248-865-9423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301048044
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: