Healthcare Provider Details

I. General information

NPI: 1093701476
Provider Name (Legal Business Name): ANDREW WADE MILLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 UNION AVE SUITE 147
DOVER OH
44622-3004
US

IV. Provider business mailing address

515 UNION AVE SUITE 147
DOVER OH
44622-3004
US

V. Phone/Fax

Practice location:
  • Phone: 330-339-6233
  • Fax: 330-343-8460
Mailing address:
  • Phone: 330-339-6233
  • Fax: 330-343-8460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number3392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: