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General NPI Number Information
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NPI Number | 1255394714
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Entity Type | Individual
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Provider Name | MICHAEL MILLER D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 676 WYOMING AVE SUITE 104
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City | KINGSTON
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State | PA
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Zip | 18704-3857
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Country | US
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Telephone | 570-287-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 480 PIERCE ST STE 205
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City | KINGSTON
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State | PA
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Zip | 18704-5512
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Country | US
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Telephone | 570-287-1400
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | OS008632L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 05008632L
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License Number State | PA
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