Healthcare Provider Details

I. General information

NPI: 1861463986
Provider Name (Legal Business Name): KEITH N MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE PATHOLOGY CONSULTANTS-CREDENTIALING
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

8166 MARKET ST PATHOLOGYCONSULTANTS-CREDENTIALS
YOUNGSTOWN OH
44512-6262
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-3768
  • Fax: 330-480-2062
Mailing address:
  • Phone: 330-953-3242
  • Fax: 330-953-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number34-00-3925-M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: