Provider Demographics
NPI:1285911156
Name:MILLER VEIN - DEARBORN
Entity type:Organization
Organization Name:MILLER VEIN - DEARBORN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-344-9110
Mailing Address - Street 1:32000 NORTHWESTERN HWY STE 215
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1570
Mailing Address - Country:US
Mailing Address - Phone:248-344-9110
Mailing Address - Fax:248-344-9111
Practice Address - Street 1:25500 MEADOWBROOK RD STE 105
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1878
Practice Address - Country:US
Practice Address - Phone:248-344-9110
Practice Address - Fax:248-344-9111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED VEIN THERAPIES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-07
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054286202K00000X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4301054286OtherJEFFREY H MILLER MD LIC #
4301054286OtherJEFFREY H MILLER MD LIC #