Healthcare Provider Details

I. General information

NPI: 1336194935
Provider Name (Legal Business Name): STEPHEN BLAINE MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5187 US ROUTE 60 E SUITE # 9
HUNTINGTON WV
25705-2076
US

IV. Provider business mailing address

5187 US ROUTE 60 E SUITE # 9
HUNTINGTON WV
25705-2076
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-2222
  • Fax: 304-399-2223
Mailing address:
  • Phone: 304-399-2222
  • Fax: 304-399-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number18744
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number81842
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: