MEDICARE: DEVON MILLER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	50.009195RX	OH
2	363AM0700X	Medical Physician Assistant	340625	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548031826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVON MILLER PA-C

Provider Business Mailing Address
First Line	:	419 E. PERKINS AVENUE
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-4901
Country	:	US
Telephone Number	:	419-557-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 HAYES AVE
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870
Country	:	US
Telephone Number	:	419-557-7455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	06/04/2026

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Directions to “ DEVON MILLER PA-C” Practice Location

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