Provider Demographics
NPI:1528814605
Name:MILLER, NATHAN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:WILLIAM
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1100 DELAPLAINE CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1840
Mailing Address - Country:US
Mailing Address - Phone:608-263-4550
Mailing Address - Fax:
Practice Address - Street 1:1121 BELLWEST BLVD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9433
Practice Address - Country:US
Practice Address - Phone:608-424-3384
Practice Address - Fax:608-424-6353
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program