Healthcare Provider Details

I. General information

NPI: 1083956395
Provider Name (Legal Business Name): MR. ERIC MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W 12TH AVE FL 4
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8315
  • Fax: 614-293-6935
Mailing address:
  • Phone: 614-293-8315
  • Fax: 614-293-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number294307
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number35.133035
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: