Healthcare Provider Details

I. General information

NPI: 1932178555
Provider Name (Legal Business Name): ELLEN G. MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST SUITE 800
LINCOLN NE
68506-1225
US

IV. Provider business mailing address

1500 S 48TH ST SUITE 800
LINCOLN NE
68506-1225
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8600
  • Fax: 402-483-8689
Mailing address:
  • Phone: 402-483-8600
  • Fax: 402-483-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number18826
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: