Healthcare Provider Details

I. General information

NPI: 1609862259
Provider Name (Legal Business Name): DENISE K MILLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 E STATE RD
NEWCOMERSTOWN OH
43832-9063
US

IV. Provider business mailing address

PO BOX 57
WEST LAFAYETTE OH
43845-0057
US

V. Phone/Fax

Practice location:
  • Phone: 740-498-5515
  • Fax: 740-498-5567
Mailing address:
  • Phone: 740-545-7919
  • Fax: 740-545-0856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: