Healthcare Provider Details

I. General information

NPI: 1477541381
Provider Name (Legal Business Name): JEAN C MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-2614
US

IV. Provider business mailing address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-2614
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-6250
  • Fax: 215-349-5800
Mailing address:
  • Phone: 215-662-6250
  • Fax: 215-349-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD062703L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD062703L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: