Healthcare Provider Details

I. General information

NPI: 1538457619
Provider Name (Legal Business Name): DEREK MILLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 83RD ST
LINCOLN NE
68505-2094
US

IV. Provider business mailing address

9210 COLBY ST
LINCOLN NE
68505-1016
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-4485
  • Fax:
Mailing address:
  • Phone: 402-483-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number346
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: