Provider Demographics
NPI:1386867117
Name:MILLER, ERIC THOMAS (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:THOMAS
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 1:20 OLIVE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3165
Mailing Address - Country:US
Mailing Address - Phone:330-379-5051
Mailing Address - Fax:
Practice Address - Street 1:1077 GORGE BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2408
Practice Address - Country:US
Practice Address - Phone:234-312-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.085153207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2966723Medicaid
OH2966723Medicaid