Healthcare Provider Details

I. General information

NPI: 1619911575
Provider Name (Legal Business Name): JEFFREY H MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MICHIGAN ST NE STE 201
GRAND RAPIDS MI
49503-2029
US

IV. Provider business mailing address

32000 NORTHWESTERN HWY STE 215
FARMINGTON HILLS MI
48334-1570
US

V. Phone/Fax

Practice location:
  • Phone: 248-344-9110
  • Fax:
Mailing address:
  • Phone: 248-344-9110
  • Fax: 248-702-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301054286
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301054286
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: