Provider Demographics
NPI:1871727503
Name:MILLER, WILLIAM G
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
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:W16484 STATE ROAD 95
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:WI
Mailing Address - Zip Code:54616-8725
Mailing Address - Country:US
Mailing Address - Phone:800-261-9699
Mailing Address - Fax:
Practice Address - Street 1:W16484 STATE ROAD 95
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:WI
Practice Address - Zip Code:54616-8725
Practice Address - Country:US
Practice Address - Phone:800-261-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41463200Medicaid