Provider Demographics
NPI:1285742759
Name:MILLER, JOSEPH K (PSYD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:K
Last Name:MILLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 DELTA RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9340
Mailing Address - Country:US
Mailing Address - Phone:989-684-6832
Mailing Address - Fax:989-684-4856
Practice Address - Street 1:2355 DELTA RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9340
Practice Address - Country:US
Practice Address - Phone:989-684-6832
Practice Address - Fax:989-684-4856
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R83664Medicare UPIN
MI0294511Medicare ID - Type Unspecified