Kennith Miller, D.O.
Individual provider Active NPI Family Medicine Physician · Spring Green, WI
NPI 1992778484 · NPPES record last updated Oct 2, 2013
Key facts
- NPI
- 1992778484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 010090 (MO)
- Practice address
- 156 W Jefferson St
Spring Green, WI 53588-8005 - Phone
- (608) 588-2600
- Fax
- (608) 588-2644
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1685 | IA | MD | Family Medicine Physician |
| 010090 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Springfield Family Medical Walk in Clinics Inc | Past |
Accepting new patients | |
| Wellpointe Family Medical | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 010090 | MO | Yes |
Addresses
Primary practice location
156 W Jefferson St
Spring Green, WI 53588-8005
Mailing address
156 W Jefferson St
Spring Green, WI 53588-8005
Phone (608) 588-2600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 245694807 | Medicaid | MO |
Other providers in Spring Green, WI
- Elaine M Makarowski
- Linda Diane McCarthy
- Steven George McCarthy
- Jennifer McFarlane
- McMiller, LLC
- Elise Byrnes Montesinos
- Stephanie Melissa Nachreiner
- Ellen L Olson
- Jillian Philipps
- Gena Reitano
All providers in Spring Green, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.