Provider Demographics
NPI:1902877335
Name:MILLER, KEVIN S (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1946 TOWN PARK BLVD
Mailing Address - Street 2:#330
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8372
Mailing Address - Country:US
Mailing Address - Phone:330-896-5077
Mailing Address - Fax:330-899-8805
Practice Address - Street 1:1946 TOWN PARK BLVD
Practice Address - Street 2:#330
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8372
Practice Address - Country:US
Practice Address - Phone:330-896-5077
Practice Address - Fax:330-899-8805
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076917M207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2261261Medicaid
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OHH122460Medicare PIN
OHH41360Medicare UPIN