Healthcare Provider Details

I. General information

NPI: 1336250547
Provider Name (Legal Business Name): RUSSELL WM MILLER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44199 DEQUINDRE SUITE 250
TROY MI
48085-1128
US

IV. Provider business mailing address

44199 DEQUINDRE SUITE 250
TROY MI
48085-1128
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-8441
  • Fax: 248-879-6841
Mailing address:
  • Phone: 248-879-8441
  • Fax: 248-879-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberRM035118
License Number StateMI

VIII. Authorized Official

Name: RUSSELL W MILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 248-879-8441