Healthcare Provider Details

I. General information

NPI: 1720942634
Provider Name (Legal Business Name): JOHN MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13955 FARMINGTON RD
LIVONIA MI
48154-5453
US

IV. Provider business mailing address

12369 GREENLAWN ST
DETROIT MI
48204-1114
US

V. Phone/Fax

Practice location:
  • Phone: 810-533-3025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: