Derrick Miller Pllc | |
22328 Trombly St Saint Clair Shores MI 48080-1362 | |
(586) 359-3924 | |
Not Available |
Full Name | Derrick Miller Pllc |
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Speciality | Social Worker |
Location | 22328 Trombly St, Saint Clair Shores, Michigan |
Authorized Official Name and Position | Derrick James Miller (OWNER) |
Authorized Official Contact | 5863593924 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Derrick Miller Pllc 22328 Trombly St Saint Clair Shores MI 48080-1362 Ph: (586) 359-3924 | Derrick Miller Pllc 22328 Trombly St Saint Clair Shores MI 48080-1362 Ph: (586) 359-3924 |
NPI Number | 1710534789 |
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Provider Enumeration Date | 08/23/2019 |
Last Update Date | 06/20/2022 |
Certification Date | 06/20/2022 |
Medicare PECOS PAC ID | 1951731488 |
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Medicare Enrollment ID | O20200423001117 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710534789 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Derrick James Miller |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1265964209 PECOS PAC ID: 2860822392 Enrollment ID: I20200423001247 |
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