Provider Demographics
NPI:1144483470
Name:MILLER, JILLIAN KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:KATHLEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:KATHLEEN
Other - Last Name:TETEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7495 STATE RD
Mailing Address - Street 2:#335
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2498
Mailing Address - Country:US
Mailing Address - Phone:513-232-5512
Mailing Address - Fax:
Practice Address - Street 1:7495 STATE RD
Practice Address - Street 2:#335
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2498
Practice Address - Country:US
Practice Address - Phone:513-232-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1557208000000X
OH35.095901208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3100950Medicaid