Basic Information
Provider Information
NPI: 1154583300
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: DANIELLE
MiddleName: MEGAN
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 335 GLESSNER AVE
Address2:  
City: MANSFIELD
State: OH
PostalCode: 449032269
CountryCode: US
TelephoneNumber: 4195202495
FaxNumber:  
Practice Location
Address1: 6905 HOSPITAL DR
Address2: SUITE 130
City: DUBLIN
State: OH
PostalCode: 430169600
CountryCode: US
TelephoneNumber: 6149230300
FaxNumber: 6149230400
Other Information
ProviderEnumerationDate: 06/30/2008
LastUpdateDate: 10/20/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X34-012151OHY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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