Healthcare Provider Details

I. General information

NPI: 1285911156
Provider Name (Legal Business Name): MILLER VEIN - DEARBORN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEADOWBROOK RD STE 105
NOVI MI
48375-1878
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: 248-344-9111
Mailing address:
  • Phone: 248-344-9110
  • Fax: 248-344-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number4301054286
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301054286
License Number StateMI

VIII. Authorized Official

Name: DR. JEFFREY H MILLER
Title or Position: OWNER
Credential: M.D.
Phone: 248-344-9110