Provider Demographics
NPI:1174160527
Name:MILLER, MARIAH LEIGHANN
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LEIGHANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 93RD ST LOWR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1835
Mailing Address - Country:US
Mailing Address - Phone:216-432-8083
Mailing Address - Fax:
Practice Address - Street 1:1301 W 93RD ST LOWR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1835
Practice Address - Country:US
Practice Address - Phone:216-432-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0377199Medicaid