Basic Information
| Provider Information | |||||||||
| NPI: | 1497838684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 CHAMBER CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAKESIDE PARK | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410171673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 580 S LOOP RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593441600 | ||||||||
| FaxNumber: | 8593440091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 02/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 17684 | KY | N | Other Service Providers | Specialist | 208600000X | 17684 | KY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 021530786 | 01 | KY | TRAVELERS MEDICARE | OTHER | 1700954 | 01 | KY | UNITED HEALTHCARE | OTHER | P00819403 | 01 | KY | RR MEDICARE - KENTUCKY | OTHER | 64176845 | 05 | KY | MEDICAID | 1459529 | 01 | KY | NGS MEDICARE PIN/PTAN | OTHER | 1497838684 | 01 | NPI | OTHER | 000000046085 | 01 | KY | ANTHEM | OTHER | 0673365 | 01 | KY | AETNA | OTHER |