Provider Demographics
NPI:1427098466
Name:MILLER, DANIEL SIVERT (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:SIVERT
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:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-234-2616
Mailing Address - Fax:319-234-1939
Practice Address - Street 1:909 E SAN MARNAN DRIVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5611
Practice Address - Country:US
Practice Address - Phone:319-234-2616
Practice Address - Fax:319-234-1939
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34049207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0234120Medicaid
IA421417307E9OtherJOHN DEERE HEALTH INS
IA26686OtherWELLMARK INS PLAN
IA421417307E9OtherJOHN DEERE HEALTH INS
IAI1940Medicare ID - Type Unspecified