Individual
KENNETH B MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 GOLD STAR BLVD, WORCESTER, MA 01606
(508) 853-2716
(508) 856-9025
Mailing address
630 PLANTATION STREET, WORCESTER, MA 01605
(508) 853-2716
(508) 856-9025
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
42854
MA
2085R0202X
Diagnostic Radiology Physician
Primary
42854
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0143138
WELFARE
—
05
—
0143138
—
MA
01
—
042472266
HEALTHCARE VALUE MANAGEME
—
01
—
1150178
FIRST HEALTH
—
01
—
1760952
CIGNA HEALTH PLAN
—
01
—
28037
HEALTHY START
—
01
—
5910031
AETNA US HEALTHCARE
—
01
—
784216
MVP HEALTH CARE
—
01
—
9900864
FALLON COMMUNITY HEALTH P
—
01
—
AA4453
HARVARD PILGRIM HEALTHCAR
—
01
—
C05296
BLUE SHIELD HMO BLUE
—
Enumeration date
04/13/2006
Last updated
02/18/2009
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