Provider Demographics
NPI:1194977116
Name:MILLER, BRIAN A (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 CHARLTON CT STE A
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6463
Mailing Address - Country:US
Mailing Address - Phone:574-533-4169
Mailing Address - Fax:574-534-8822
Practice Address - Street 1:1814 CHARLTON CT STE A
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6463
Practice Address - Country:US
Practice Address - Phone:574-533-4169
Practice Address - Fax:574-534-8822
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086687A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194977116OtherNPI
AZ550681Medicaid
8HN178Medicare UPIN
1194977116OtherNPI