Individual
AMANDA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
655 KENMOOR AVE SE, SUITE 200, GRAND RAPIDS, MI 49546-8622
(616) 949-5600
(616) 949-6571
Mailing address
655 KENMOOR AVE SE, SUITE 200, GRAND RAPIDS, MI 49546-8622
(616) 949-5600
(616) 949-6571
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
5601005922
MI
363A00000X
Physician Assistant
Primary
5601005922
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601005922
STATE LICENSE
MI
Enumeration date
05/04/2011
Last updated
08/08/2018
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