Individual
KENNETH R MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1401 E VAN BUREN AVE, MCALESTER, OK 74501-4245
(918) 426-0240
(918) 423-4051
Mailing address
6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3347
(918) 488-6001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
8816
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0166707
UMWA
OK
05
—
100104840A
—
OK
01
—
1324230001
PALMETTO DME
OK
01
—
730710406020
BC/BS
OK
01
—
731310891006
UNICARE
OK
01
—
7313108931028
TRICARE SOUTH
OK
01
—
74502A010
CHAMPUS (WPS)
OK
01
—
D35047
STERLING OPTION 1
OK
Enumeration date
04/10/2006
Last updated
08/15/2012
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