Provider Demographics
NPI:1063437812
Name:MILLER, DANIEL CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CHARLES
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E COURT AVE
Mailing Address - Street 2:STE 305
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2057
Mailing Address - Country:US
Mailing Address - Phone:515-421-3679
Mailing Address - Fax:515-237-3979
Practice Address - Street 1:12871 UNIVERSITY AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8255
Practice Address - Country:US
Practice Address - Phone:515-222-4419
Practice Address - Fax:515-222-6965
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1073585Medicaid
IA1073585Medicaid
IAI15363Medicare ID - Type Unspecified