Healthcare Provider Details

I. General information

NPI: 1477089159
Provider Name (Legal Business Name): JACOB MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

3331 AMELIAMONT AVE
CINCINNATI OH
45209-1806
US

V. Phone/Fax

Practice location:
  • Phone: 304-617-8377
  • Fax:
Mailing address:
  • Phone: 304-617-8377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME146229
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35.145357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: