Healthcare Provider Details

I. General information

NPI: 1710479985
Provider Name (Legal Business Name): KIMBERLY S MILLER M.A.E.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E WASHINGTON ST STE 150
MEDINA OH
44256-3339
US

IV. Provider business mailing address

807 E WASHINGTON ST STE 150
MEDINA OH
44256-3339
US

V. Phone/Fax

Practice location:
  • Phone: 330-241-4444
  • Fax: 330-721-0013
Mailing address:
  • Phone: 330-241-4444
  • Fax: 330-721-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: