Basic Information
| Provider Information | |||||||||
| NPI: | 1790957033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANDRA MILLER MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 643865 | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452643865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137218272 | ||||||||
| FaxNumber: | 5137210333 | ||||||||
| Practice Location | |||||||||
| Address1: | 2123 AUBURN AVE | ||||||||
| Address2: | SUITE 442 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137218272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 09/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5137218272 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2851945 | 05 | OH | MEDICAID |