Provider Demographics
NPI:1336211432
Name:MILLER, SAMUEL K (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:K
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:543 N SHIPLEY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-2339
Mailing Address - Country:US
Mailing Address - Phone:302-629-8662
Mailing Address - Fax:302-629-7661
Practice Address - Street 1:543 N SHIPLEY ST
Practice Address - Street 2:SUITE A
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-2339
Practice Address - Country:US
Practice Address - Phone:302-629-8662
Practice Address - Fax:302-629-7661
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0005891208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001098601Medicaid
DE0001098601Medicaid