Individual
JEROME TIMOTHY MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
Mailing address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
726-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629034798
—
WI
Enumeration date
04/26/2006
Last updated
07/21/2022
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