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General NPI Number Information
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NPI Number | 1073076634
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Entity Type | Individual
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Provider Name | EVAN MARK MILLER MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 2619 CULVER RD STE 2A
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City | ROCHESTER
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State | NY
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Zip | 14609-1738
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Country | US
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Telephone | 585-342-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 100 KINGS HWY S
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City | ROCHESTER
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State | NY
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Zip | 14617-5504
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Country | US
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Telephone |
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Fax |
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 336274
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 336274
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 83677-20
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License Number State | WI
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