Healthcare Provider Details

I. General information

NPI: 1104808880
Provider Name (Legal Business Name): JON E. MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4907A DALBEY LANE
BERLIN OH
44610
US

IV. Provider business mailing address

PO BOX 366
BERLIN OH
44610-0366
US

V. Phone/Fax

Practice location:
  • Phone: 330-893-2941
  • Fax: 330-893-3027
Mailing address:
  • Phone: 330-893-2941
  • Fax: 330-893-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35077859
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: