Healthcare Provider Details

I. General information

NPI: 1548376122
Provider Name (Legal Business Name): BOYD MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7861 STATE ROAD 60
CEDARBURG WI
53012-9305
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 262-546-1050
  • Fax: 262-546-1051
Mailing address:
  • Phone: 414-266-7615
  • Fax: 414-266-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31069
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: