MEDICARE: JOHN B MILLER M.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	208600000X	Surgery Physician	26629	MN

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	:	1851335764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN B MILLER M.D.

Provider Business Mailing Address
First Line	:	1973 SLOAN PL
Second Line	:	#225
City	:	MAPLEWOOD
State	:	MN
Zip	:	55117-2084
Country	:	US
Telephone Number	:	651-224-1347
Fax Number	:	651-776-0932

Provider Business Practice Location Address
First Line	:	1973 SLOAN PL
Second Line	:	#225
City	:	MAPLEWOOD
State	:	MN
Zip	:	55117-2084
Country	:	US
Telephone Number	:	651-224-1347
Fax Number	:	651-776-0932

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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