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General NPI Number Information
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NPI Number | 1962543496
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Entity Type | Individual
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Provider Name | KENNETH ANDREW MILLER MD
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 611 SHERMAN AVE E
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City | FORT ATKINSON
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State | WI
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Zip | 53538-1960
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Country | US
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Telephone | 920-568-6090
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Fax | 920-568-6083
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Provider Business Mailing Address
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Address Line | 611 SHERMAN AVE E
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City | FORT ATKINSON
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State | WI
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Zip | 53538-1960
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Country | US
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Telephone | 920-568-6090
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Fax | 920-568-6083
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 11253504-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | M-13495
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 29654
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License Number State | WI
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