Individual
KENNON MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
450 VETERANS MEMORIAL PKWY, BUILDING 14, E PROVIDENCE, RI 02914-5300
(401) 435-6600
Mailing address
144 WOODBURY ST, PROVIDENCE, RI 02906-3546
(401) 435-6600
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD11459
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27549
BLUE SHIELD
RI
05
—
9003513
—
RI
Enumeration date
08/31/2006
Last updated
02/20/2009
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