Healthcare Provider Details

I. General information

NPI: 1326044280
Provider Name (Legal Business Name): PETER R MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30781 STEPHENSON HWY
MADISON HTS MI
48071-1618
US

IV. Provider business mailing address

30781 STEPHENSON HWY
MADISON HTS MI
48071-1618
US

V. Phone/Fax

Practice location:
  • Phone: 248-585-0234
  • Fax: 248-585-0234
Mailing address:
  • Phone: 248-583-8922
  • Fax: 248-583-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301030094
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: