Healthcare Provider Details

I. General information

NPI: 1548921570
Provider Name (Legal Business Name): ADAM JOSEPH MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 CARNEGIE AVE
CLEVELAND OH
44106-2130
US

IV. Provider business mailing address

10201 CARNEGIE AVE
CLEVELAND OH
44106-2130
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-6833
  • Fax: 216-444-9464
Mailing address:
  • Phone: 216-444-6833
  • Fax: 216-444-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008155RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: