Healthcare Provider Details

I. General information

NPI: 1326953167
Provider Name (Legal Business Name): JUSTIN MILLER FP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 FORRER BLVD
KETTERING OH
45420-3640
US

IV. Provider business mailing address

3008 PATSIE DR
BEAVERCREEK OH
45434-6147
US

V. Phone/Fax

Practice location:
  • Phone: 937-762-5927
  • Fax:
Mailing address:
  • Phone: 937-790-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0104305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: