MEDICARE: KEITH A MILLER LMSW

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	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker	6801088754	MI

General Provider Information

NPI Number	:	1831300698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH A MILLER LMSW

Provider Business Mailing Address
First Line	:	36400 WOODWARD AVE STE 125
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-0904
Country	:	US
Telephone Number	:	248-709-4588
Fax Number	:

Provider Business Practice Location Address
First Line	:	36400 WOODWARD AVE STE 125
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-0904
Country	:	US
Telephone Number	:	248-709-4588
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/21/2022

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