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General NPI Number Information
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NPI Number | 1013950922
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Entity Type | Individual
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Provider Name | JOHN J MILLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 1901 E CAPITOL DR
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City | SHOREWOOD
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State | WI
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Zip | 53211-2335
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Country | US
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Telephone | 414-962-7477
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Fax | 414-962-2420
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Provider Business Mailing Address
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Address Line | 4425 N PORT WASHINGTON RD ATTN: CSMCP CLINIC CREDENTIALING
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City | GLENDALE
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State | WI
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Zip | 53212-1082
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Country | US
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Telephone | 414-962-7477
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Fax | 414-962-2420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23158
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License Number State | WI
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