Provider Demographics
NPI:1477438992
Name:MILLER, MICHAEL ROSS
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROSS
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 NICOLET AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-1633
Mailing Address - Country:US
Mailing Address - Phone:920-379-9858
Mailing Address - Fax:
Practice Address - Street 1:909 NICOLET AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-1633
Practice Address - Country:US
Practice Address - Phone:920-379-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302416176183500000X
WI12457-40183500000X
PARP041810L183500000X
OH03444817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist