Healthcare Provider Details

I. General information

NPI: 1720166424
Provider Name (Legal Business Name): DANIEL MILLER MA., LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3564 CARROLLTON RD
SAGINAW MI
48603-3944
US

IV. Provider business mailing address

3564 CARROLLTON RD
SAGINAW MI
48603-3944
US

V. Phone/Fax

Practice location:
  • Phone: 989-755-0605
  • Fax: 989-755-0605
Mailing address:
  • Phone: 989-755-0605
  • Fax: 989-755-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009486
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801058819
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: