Individual
RANDALL MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1601 NW 114TH ST, CLIVE, IA 50325-7007
(515) 222-7000
(515) 222-2737
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 222-7000
(515) 222-2737
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01813
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068119
WELLMARK-MANAGED CARE
IA
05
—
1181123
—
IA
01
—
51297
WELLMARK
IA
01
—
6271T2
JOHN DEERE
IA
Enumeration date
08/15/2006
Last updated
04/10/2009
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