Provider Demographics
NPI:1528140555
Name:MILLER, TROY LEE (DO)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 BETTEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333
Mailing Address - Country:US
Mailing Address - Phone:402-826-2102
Mailing Address - Fax:402-826-7950
Practice Address - Street 1:2910 BETTEN DRIVE
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333
Practice Address - Country:US
Practice Address - Phone:402-826-2102
Practice Address - Fax:402-826-7950
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE253207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0254656Medicaid
IA0689091Medicaid
IA0226134Medicaid
IA0638593Medicaid
IA42047Medicare ID - Type UnspecifiedPART B GROUP #
IA0689091Medicaid
IA163875AMedicare ID - Type UnspecifiedRHC # SANBORN
IA0226134Medicaid
IA168909Medicare ID - Type UnspecifiedRHC # LAKE PARK
IA0638593Medicaid
NE086470001Medicare PIN
IA55368Medicare ID - Type UnspecifiedPART B GROUP # LAKE PARK
IA0254656Medicaid