Healthcare Provider Details

I. General information

NPI: 1164407037
Provider Name (Legal Business Name): RONALD STANLEY MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN ROAD 385
COLUMBUS OHIO
43202
UM

V. Phone/Fax

Practice location:
  • Phone: 614-293-6255
  • Fax: 614-293-8518
Mailing address:
  • Phone: 614-947-3700
  • Fax: 614-947-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35-04-0685-M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: