JERRY J MILLER (NPI# 1497758049) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497758049 |
| Entity Type | Individual |
| Full Name | JERRY J MILLER |
| Credential | MD |
| Practice Address |
111 Wisconsin American Dr Fond Du Lac WI 54937-6725 |
| Mailing Address |
801 York St Manitowoc WI 54220-4630 |
| Practice Telephone | 9209230788 |
| Practice Fax Number | 9202730085 |
| Mailing Telephone | (920) 663-9146 |
| Mailing Fax Number | 9206841439 |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 30596 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1497758049 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1440 N 25th St, Sheboygan, WI 530813108 | 9204579100 | 9204571461 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811255201 | Jerry Paul Miller IIi | Student in an Organized Health Care Education/Training Program | 1516 Aztec Ave, Apt#209, Metairie, LA 70005-1266 | 2012-04-24 |
| 1992021414 | Jerry Wade Miller | Case Manager/Care Coordinator | 133 Mckinney St Ste 202, Farmersville, TX 75442-2221 | 2010-04-08 |
| 1144435801 | Jerry P Miller | Contractor | 1605 W G St, Elizabethton, TN 37643-2832 | 2007-05-14 |
| 1235257288 | Jerry L. Miller | Psychologist | 930 Cambridge St Ste 107, Fayetteville, NC 28303-5356 | 2007-03-27 |
| 1356382014 | Jerry Miller | Chiropractor | 8501 E Mill Plain Blvd, Vancouver, WA 98664-2010 | 2006-06-10 |
| 1811936511 | Jerry W. Miller | Internal Medicine | 1330 E. Yandell Drive, El Paso, TX 79902-5529 | 2006-06-06 |
| 1871543199 | Jerry Miller | Family Medicine | 211 13th St, Ramona, CA 92065-2711 | 2006-05-10 |
| 1669431128 | Jerry L Miller | Internal Medicine | 890 Westfall Rd, Suite A, Rochester, NY 14618-2610 | 2006-03-22 |
| 1306121629 | Jerry Robert Miller | Pharmacist | 7975 E Us Highway 36, Avon, IN 46123-7975 | 2011-10-18 |
| 1790795367 | Jerry E Miller | Counselor | 209 N 10th St, Hamilton, MT 59840-2357 | 2006-08-08 |
| Street Address |
111 WISCONSIN AMERICAN DR |
| City | FOND DU LAC |
| State | WI |
| Zip Code | 54937-6725 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568789279 | Matthew Joseph Fanelli | Dermatology | 111 Wisconsin American Dr, Fond Du Lac, WI 54937-6725 | 2010-04-21 |
| 1306085998 | Forefront Dermatology, S.c. | Dermatology | 111 Wisconsin American Dr, Fond Du Lac, WI 54937 | 2009-02-05 |
| 1942344346 | Paula Lin | Dermatology | 111 Wisconsin American Dr, Fond Du Lac, WI 54937-6725 | 2007-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710523774 | Lisa Diane Brown | Social Worker | W3950 Wi-23 Trunk, Fond Du Lac, WI 54937 | 2019-11-25 |
| 1538700083 | Kristine Karpen | Technician | 1812 Thurke Ave, North Fond Du Lac, WI 54937 | 2019-10-07 |
| 1962719245 | James Hugh Rupple | Ophthalmology | W4410 Mary Hill Park, Fond Du Lac, WI 54937 | 2010-09-08 |
| 1467591131 | Rosonna Sue Comers | Social Worker | N6687 Wrightway Dr, Ste D, Fond Du Lac, WI 54937 | 2007-02-06 |
| 1487731741 | Daniel James Kierstead | Optometrist | 377 N Rollings Meadows Dr, Fond Du Lac, WI 54937 | 2006-11-01 |
| 1528519758 | Betty Xiong | Physician Assistant | 210 Wisconsin American Dr, Fond Du Lac, WI 54937 | 2016-10-24 |
| 1598112963 | Jennifer M Halbach | Nurse Practitioner | 210 Wisconsin American Dr, Fond Du Lac, WI 54937 | 2016-05-16 |
| 1548667231 | Tanya Watry | Physician Assistant | 210 Wisconsin American Dr, Fond Du Lac, WI 54937 | 2014-11-25 |
| 1578813606 | Joline Brotzman | Nurse Practitioner | 700 Park Ridge Ln, North Fond Du Lac, WI 54937 | 2012-09-17 |
| 1407030067 | Adriana Arguello | Internal Medicine | 210 Wisconsin American Dr, Fond Du Lac, WI 54937 | 2007-12-19 |
| Find all providers in zip 54937 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174016596 | Dermatology and Cosmetic Physicians, Sc | Dermatology | W5192 Rienzi Rd, Fond Du Lac, WI 54935-9603 | 2018-06-11 |
| 1093104887 | Adam P Whittington | Dermatology | 210 Wisconsin American Dr, Fond Du Lac, WI 54937-2999 | 2015-01-15 |
| 1861756538 | Suzanne T Mcgoey | Dermatology | 912 S Hickory St, Fond Du Lac, WI 54935-5530 | 2012-06-27 |
| 1568789279 | Matthew Joseph Fanelli | Dermatology | 111 Wisconsin American Dr, Fond Du Lac, WI 54937-6725 | 2010-04-21 |
| 1548449614 | Burt James Steffes | Dermatology | 145 N Main St, Fond Du Lac, WI 54935-3423 | 2007-10-25 |
| 1689760381 | Michael Lyle Tjoelker | Dermatology | 145 N Main St, Fond Du Lac, WI 54935-3423 | 2006-10-04 |
| 1780660308 | James E Schuster | Dermatology | 145 N Main St, Fond Du Lac, WI 54935-3423 | 2005-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194248013 | Kyle Erick Rudningen | Dermatology | Uw Hosptials & Clinics 600 Highland Ave, Madison, WI 53792 | 2017-07-23 |
| 1194255521 | Rhonda Ganansky | Dermatology | W1383 N Bloomfield Rd, Lake Geneva, WI 53147-4429 | 2017-06-18 |
| 1356891402 | Forefront Dermatology, S.c. | Dermatology | 1515 S Green Bay Rd, Racine, WI 53406 | 2016-10-12 |
| 1982066239 | Margaret Coleman Maxi | Dermatology | 188 Rockwood Ln Ste A, Neenah, WI 54956-1983 | 2016-03-25 |
| 1447612312 | Andrew C Duncanson | Dermatology | 510 N 17th Ave Ste C, Wausau, WI 54401-4281 | 2016-03-22 |
| 1225411481 | Gabriela A Maloney | Dermatology | 17100 W North Ave Ste 200, Brookfield, WI 53005-4489 | 2015-07-07 |
| 1043604424 | Marthe Ngongang Dika | Dermatology | 10500 W Loomis Rd Ste 110, Franklin, WI 53132-8030 | 2015-03-24 |
| 1902205206 | Affiliated Dermatologists | Dermatology | N96w17035 Division Rd, Suite A, Germantown, WI 53022-6419 | 2014-08-22 |
| 1568882793 | Kassandra E Holzem | Dermatology | 195 Discovery Dr, Brookfield, WI 53045 | 2014-04-28 |
| 1205253242 | Namita Jain | Dermatology | 3003 W Good Hope Rd Ste 1-200, Milwaukee, WI 53209-2042 | 2014-03-27 |
| Find all providers with the same taxonomy | ||||
| City | FOND DU LAC |
| Zip Code | 54937 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.