Healthcare Provider Details

I. General information

NPI: 1508028564
Provider Name (Legal Business Name): CAMERON KENNEDY MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 EXECUTIVE CAMPUS DR SUITE 160
WESTERVILLE OH
43082-9838
US

IV. Provider business mailing address

507 EXECUTIVE CAMPUS DR SUITE 160
WESTERVILLE OH
43082-9838
US

V. Phone/Fax

Practice location:
  • Phone: 614-891-9505
  • Fax: 614-891-6416
Mailing address:
  • Phone: 614-891-9505
  • Fax: 614-891-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.094937
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: