Healthcare Provider Details

I. General information

NPI: 1922497718
Provider Name (Legal Business Name): MR. WILLIAM MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27526 DUPREE ST
ROMULUS MI
48174-9516
US

IV. Provider business mailing address

27526 DUPREE ST
ROMULUS MI
48174-9516
US

V. Phone/Fax

Practice location:
  • Phone: 734-795-6396
  • Fax:
Mailing address:
  • Phone: 734-795-6396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2909203
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: