Provider Demographics
NPI:1174714844
Name:MILLER, DAVID WARREN (MD, LAC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WARREN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25001 EMERY RD BLDG 25
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5626
Mailing Address - Country:US
Mailing Address - Phone:773-960-8901
Mailing Address - Fax:866-259-4969
Practice Address - Street 1:25001 EMERY RD STE 100
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5627
Practice Address - Country:US
Practice Address - Phone:773-960-8901
Practice Address - Fax:866-259-4969
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000602171100000X
IL036-100091208D00000X
IL036100091208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No171100000XOther Service ProvidersAcupuncturist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice