Provider Demographics
NPI:1992741672
Name:MILLER, KIM L (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
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 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5502
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-2827
Practice Address - Country:US
Practice Address - Phone:513-556-2564
Practice Address - Fax:513-556-1337
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 079279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-09563OtherUNITED
OH2338714Medicaid
KY7100404580Medicaid
000000333281OtherANTHEM
79279-03OtherHUMANA
79279-03OtherHUMANA
OHMI4087256Medicare ID - Type Unspecified
04-09563OtherUNITED
OH2338714Medicaid
KY7100404580Medicaid