Healthcare Provider Details

I. General information

NPI: 1477293173
Provider Name (Legal Business Name): KYLE MICHAEL MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S GRANT AVE
COLUMBUS OH
43215-4701
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-8883
  • Fax: 614-566-8149
Mailing address:
  • Phone: 614-544-6366
  • Fax: 614-544-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.018465
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.018465
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: