Individual
ALLISON RIEKSE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
35 MICHIGAN NE, SUITE 3003, GRAND RAPIDS, MI 49503
(616) 267-2200
(616) 267-2201
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005929
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M74460419
MEDICARE ID
MI
01
—
5601005929
PA TASK FORCE LICENSE
MI
Enumeration date
10/25/2010
Last updated
06/17/2013
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