Individual
JUSTIN MICHAEL MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1111 LEFFINGWELL AVE NE, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
Mailing address
1111 LEFFINGWELL AVE NE, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
(616) 954-6483
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-01677
NC
363AS0400X
Surgical Physician Assistant
Primary
5601006970
MI
Other
Enumeration date
02/05/2009
Last updated
05/16/2014
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