Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301116121 | MI |
Y | 2080P0204X | Pediatric Emergency Doctor | 4301116121 | MI |
NPI | 1134509144 |
---|---|
Provider Name | Jason P Miller |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 13/12/2018 |