Provider Demographics
NPI:1720047863
Name:MILLER, ERIC D (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:211 CORPORATE DR STE H
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3119
Mailing Address - Country:US
Mailing Address - Phone:920-219-4599
Mailing Address - Fax:920-306-8018
Practice Address - Street 1:211 CORPORATE DR STE H
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3119
Practice Address - Country:US
Practice Address - Phone:920-219-4599
Practice Address - Fax:920-306-8018
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI35615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine