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Individual
KENNON MILLER
Active
Individual
KENNON MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD11459
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27549
BLUE SHIELD
RI
05
—
9003513
—
RI
Enumeration date
08/31/2006
Last updated
02/20/2009
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