Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25084 | KY |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25084 | KY |
NPI | 1720078264 |
---|---|
Provider Name | Dr. Theodore H Miller |
First Address | Fort Thomas, KY 41075-1765 |
Second Address | Ft. Thomas, KY 41075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 27/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000033216 | ANTHEM BC/BS (01) | |
64250848 | (05) | OH |