1699911974 NPI number — MELVIN SAMUEL MILLER LMSW

Table of content: MELVIN SAMUEL MILLER LMSW (NPI 1699911974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699911974 NPI number — MELVIN SAMUEL MILLER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
MELVIN
Provider Middle Name:
SAMUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699911974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24280 ROUGECREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48033-2882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-875-7601
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 BAGLEY ST
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48226-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-961-4890
Provider Business Practice Location Address Fax Number:
313-961-5120
Provider Enumeration Date:
12/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6801046049 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6801046049 . This is a "STATE OF MICHIGAN BOARD OF SOCIAL WORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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