Provider Demographics
NPI:1093936692
Name:MILLER, JOE (MD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:MILLER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78-6831 ALII DR STE 328
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-4408
Mailing Address - Country:US
Mailing Address - Phone:808-909-3139
Mailing Address - Fax:
Practice Address - Street 1:78-6831 ALII DR STE 328
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-4408
Practice Address - Country:US
Practice Address - Phone:808-909-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242356208800000X
GUM-2402208800000X
IL125-050838208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology