Kelly Michael Miller, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

Commanding Officer Medical Company
CSSG-3 Box 63067 MCBH
Kaneohe Bay, HI 96863

Phone

(808) 257-1572

NPI assigned

May 22, 2007

Sex

Male

Sole proprietor

No

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205045481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46-271 KAHUHIPA ST APT E109",
            "city": "KANEOHE",
            "state": "HI",
            "postal_code": "967446024",
            "telephone_number": "808-271-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COMMANDING OFFICER MEDICAL COMPANY",
            "address_2": "CSSG-3 BOX 63067 MCBH",
            "city": "KANEOHE BAY",
            "state": "HI",
            "postal_code": "96863",
            "telephone_number": "808-257-1572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KELLY",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek L Foerschler, D.O.
• Mavis Keiko Gushiken, RDH
• Eulogio Quintos Gutierrez, IDC
• Patrick Warren Horgan
• Thomas Jordan, DDS
• Hai Duc Nguyen, RDH
• NHC Hawaii
• Melissa Nicole Pauli, D.M.D.
• Jacob Roskelley, D.M.D
• Michael Winkle, INDEPENDENT DUTY COR

• All providers in Kaneohe Bay, HI
• Independent Duty Corpsman in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.