Individual
MARK L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4521 OUTER LOOP, LOUISVILLE, KY 40219-3856
(502) 653-5206
(877) 688-0102
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02963
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000526905
ANTHEM
KY
01
—
2831247000
PASSPORT ADVANTAGE
KY
01
—
50014320
PASSPORT
KY
05
—
64123722
—
KY
Enumeration date
08/16/2006
Last updated
03/19/2026
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