Basic Information
| Provider Information | |||||||||
| NPI: | 1275509911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 WILLIAM HOWARD TAFT, PHYS DIV | ||||||||
| Address2: | 2ND FL, CBO2-3, ATTN: CREDENTIALING | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132638571 | ||||||||
| FaxNumber: | 5133664480 | ||||||||
| Practice Location | |||||||||
| Address1: | 2123 AUBURN AVE | ||||||||
| Address2: | SUITE 442 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137218272 | ||||||||
| FaxNumber: | 5137210333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 31135 | KS | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 35-078131 | OH | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 35-078131 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2183051 | 01 | OH | MEDICAID | OTHER | 5902567 | 01 | OH | AETNA | OTHER | 270577733067 | 01 | OH | CARESOURCE | OTHER | 763200 | 01 | OH | ANTHEM | OTHER | H109180 | 01 | OH | MEDICARE | OTHER | 681757 | 01 | OH | WELLCARE | OTHER | 1630469 | 01 | OH | GATEWAY HEALTH | OTHER | 200310530A | 05 | KS | MEDICAID | P01239196 | 01 | OH | RAILROAD MEDICARE | OTHER | 200304120 | 01 | IN | MEDICAID | OTHER |