Provider Demographics
NPI:1124120407
Name:MILLER, MARCUS (MD)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
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:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45359-0556
Mailing Address - Country:US
Mailing Address - Phone:937-676-2033
Mailing Address - Fax:
Practice Address - Street 1:915 WEST MICHIGAN STREET
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365
Practice Address - Country:US
Practice Address - Phone:937-492-7296
Practice Address - Fax:937-498-5544
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350296252083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7232041Medicare ID - Type Unspecified
C00725Medicare UPIN