Healthcare Provider Details

I. General information

NPI: 1891791026
Provider Name (Legal Business Name): MONICA A MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PHILADELPHIA DR STE 441
DAYTON OH
45406-1840
US

IV. Provider business mailing address

2200 PHILADELPHIA DR STE 441
DAYTON OH
45406-1840
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-4690
  • Fax: 937-567-4186
Mailing address:
  • Phone: 937-734-4690
  • Fax: 937-567-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35075412
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.075412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: