Provider Demographics
NPI:1720086226
Name:MILLER, ROSS D (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:451 HIDDEN MEADOWS DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9812
Mailing Address - Country:US
Mailing Address - Phone:517-437-0010
Mailing Address - Fax:517-437-0319
Practice Address - Street 1:451 HIDDEN MEADOWS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9812
Practice Address - Country:US
Practice Address - Phone:517-437-0010
Practice Address - Fax:517-437-0319
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301056697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2674131Medicaid
MIP89539OtherBCN
MI0120143OtherPHP
MI0803013841OtherBCBS
MI080031248OtherMEDICARE
MI102202OtherGLHP
MI102202OtherGLHP
MI0120143OtherPHP