Individual
THEODORE D MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
835 PARKSIDE ST, RIPON, WI 54971-8505
(920) 745-3530
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
30240
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160027550
RAILROAD MEDICARE
WI
05
—
31494200
—
WI
Enumeration date
11/15/2005
Last updated
11/18/2020
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