Provider Demographics
NPI:1386600617
Name:MILLER, JOSHUA (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
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:NORTHWESTERN UNIVERSITY FIENBERG SCHOOL OF MEDICINE
Mailing Address - Street 2:303 EAST CHICAGO AVENUE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1005
Mailing Address - Country:US
Mailing Address - Phone:312-695-0359
Mailing Address - Fax:312-695-9194
Practice Address - Street 1:NORTHWESTERN UNIVERSITY, FIENBERG SCHOOL OF MEDICINE
Practice Address - Street 2:303 EAST CHICAGO AVENUE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1005
Practice Address - Country:US
Practice Address - Phone:312-695-0359
Practice Address - Fax:312-695-9194
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34131204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL92953Medicare ID - Type Unspecified
FLD66020Medicare UPIN