Provider Demographics
NPI:1154571867
Name:MILLER, NATHANIEL JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:JOHN
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 1:4800 HAPPY CANYON RD STE 220
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1074
Mailing Address - Country:US
Mailing Address - Phone:303-888-3311
Mailing Address - Fax:720-707-1627
Practice Address - Street 1:325 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3134
Practice Address - Country:US
Practice Address - Phone:720-593-6523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125052478208100000X
MO2011011361208100000X
CODR.0055868208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85770108Medicaid
CO85770108Medicaid
MO132680232Medicare PIN
CO85770108Medicaid