Basic Information
| Provider Information | |||||||||
| NPI: | 1063437812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E COURT AVE | ||||||||
| Address2: | STE 305 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503092057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154213679 | ||||||||
| FaxNumber: | 5152373979 | ||||||||
| Practice Location | |||||||||
| Address1: | 12871 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152224419 | ||||||||
| FaxNumber: | 5152226965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02745 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1073585 | 05 | IA | MEDICAID |