Healthcare Provider Details

I. General information

NPI: 1659365997
Provider Name (Legal Business Name): SCOTT M MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W BROAD ST SUITE 220
COLUMBUS OH
43222-1464
US

IV. Provider business mailing address

3400 OLENTANGY RIVER RD OHIO GASTROENTEROLOGY GROUP INC
COLUMBUS OH
43202-1523
US

V. Phone/Fax

Practice location:
  • Phone: 614-754-5500
  • Fax: 614-754-5501
Mailing address:
  • Phone: 614-754-5500
  • Fax: 614-457-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35055034
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: