Healthcare Provider Details

I. General information

NPI: 1578829149
Provider Name (Legal Business Name): GEORGE E MILLER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2012
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE EMERGENCY DEPARTMENT
GRAYLING MI
49738-1312
US

IV. Provider business mailing address

1209 CASS ST
TRAVERSE CITY MI
49684-4145
US

V. Phone/Fax

Practice location:
  • Phone: 989-348-5461
  • Fax:
Mailing address:
  • Phone: 912-484-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number43011008967
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.206247
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: