Provider Demographics
NPI:1871519660
Name:MILLER, STEPHEN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 MAPLEWOOD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-8016
Mailing Address - Country:US
Mailing Address - Phone:304-753-9100
Mailing Address - Fax:304-753-9353
Practice Address - Street 1:3115 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:PETERSTOWN
Practice Address - State:WV
Practice Address - Zip Code:24963-5040
Practice Address - Country:US
Practice Address - Phone:304-753-9100
Practice Address - Fax:304-753-9353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1608207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5630144000Medicaid
WV5630144000Medicaid
513914Medicare PIN
WVH00326Medicare UPIN