Healthcare Provider Details

I. General information

NPI: 1790957033
Provider Name (Legal Business Name): SANDRA MILLER MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE SUITE 442
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

PO BOX 643865
CINCINNATI OH
45264-3865
US

V. Phone/Fax

Practice location:
  • Phone: 513-721-8272
  • Fax:
Mailing address:
  • Phone: 513-721-8272
  • Fax: 513-721-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA L MILLER
Title or Position: CEO
Credential: MD
Phone: 513-721-8272