Healthcare Provider Details

I. General information

NPI: 1629277579
Provider Name (Legal Business Name): STEPHEN R MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 KIRTS BLVD
TROY MI
48084-4846
US

IV. Provider business mailing address

1172 KIRTS BLVD
TROY MI
48084-4846
US

V. Phone/Fax

Practice location:
  • Phone: 248-244-2067
  • Fax: 248-244-9131
Mailing address:
  • Phone: 248-244-2067
  • Fax: 248-244-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101006529
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: