Provider Demographics
NPI:1760952436
Name:MILLER, DEVIN THADDEUS (MD)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:THADDEUS
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 UNIVERSITY ROW STE 200
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1465
Mailing Address - Country:US
Mailing Address - Phone:608-263-6400
Mailing Address - Fax:
Practice Address - Street 1:749 UNIVERSITY ROW STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1465
Practice Address - Country:US
Practice Address - Phone:608-263-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2025-05-13
Deactivation Date:2021-03-18
Deactivation Code:
Reactivation Date:2022-04-26
Provider Licenses
StateLicense IDTaxonomies
CAA198977207P00000X
WI83147-20390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI83147-20OtherREGULAR MEDICAL LICENSE