MEDICARE: DR. JEROME M MILLER PH.D.

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	103TC0700X	Clinical Psychologist	6301001918	MI

General Provider Information

NPI Number	:	1689617193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME M MILLER PH.D.

Provider Business Mailing Address
First Line	:	400 MAYNARD ST
Second Line	:	SUITE 503
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-2440
Country	:	US
Telephone Number	:	734-761-5347
Fax Number	:	734-663-4327

Provider Business Practice Location Address
First Line	:	400 MAYNARD ST
Second Line	:	SUITE 503
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-2440
Country	:	US
Telephone Number	:	734-761-5347
Fax Number	:	734-663-4327

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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