Provider Demographics
NPI:1215936737
Name:MILLER, JAMES R (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-1887
Mailing Address - Country:US
Mailing Address - Phone:574-389-5042
Mailing Address - Fax:574-522-8505
Practice Address - Street 1:1753 FULTON ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1927
Practice Address - Country:US
Practice Address - Phone:574-389-9881
Practice Address - Fax:574-389-9884
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01018808A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100111270Medicaid
IN000000545669OtherANTHEM BCBS
IN000000551983OtherANTHEM, BCBS FMC
IN000000109323OtherANTHEM BCBS #
IN100111270AMedicaid
IN000000109323OtherANTHEM BCBS #
INM400044264Medicare PIN
IN100111270Medicaid
IN000000545669OtherANTHEM BCBS
IN000000551983OtherANTHEM, BCBS FMC
IN080162536 RR MED #Medicare PIN