Individual
RUSSELL M MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5838 W BRICK RD STE 106, SOUTH BEND, IN 46628-8420
(574) 247-1911
(574) 247-1912
Mailing address
PO BOX 1239, TROY, MI 48099-1239
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01055937A
IN
207QG0300X
Geriatric Medicine (Family Medicine) Physician
01055937A
IN
207QG0300X
Geriatric Medicine (Family Medicine) Physician
036068129
IL
Other
Enumeration date
12/13/2006
Last updated
07/13/2015
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