Healthcare Provider Details

I. General information

NPI: 1407888647
Provider Name (Legal Business Name): DENNIS P MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N11070 RIVER LN
GERMANTOWN WI
53022-3109
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-535-8400
  • Fax:
Mailing address:
  • Phone: 262-535-8400
  • Fax: 414-259-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number27046
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number27046
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: