Provider Demographics
NPI:1316072242
Name:MICHAEL S. MILLER DO, FACOS, CWS, PC
Entity type:Organization
Organization Name:MICHAEL S. MILLER DO, FACOS, CWS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-429-0061
Mailing Address - Street 1:3850 SHORE DR STE 315
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4693
Mailing Address - Country:US
Mailing Address - Phone:317-491-0061
Mailing Address - Fax:317-222-1953
Practice Address - Street 1:3850 SHORE DR STE 315
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4693
Practice Address - Country:US
Practice Address - Phone:317-429-0061
Practice Address - Fax:317-222-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
IN02001905208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200044490AMedicaid
IN200044490AMedicaid
INE29898Medicare UPIN
IN190650Medicare ID - Type Unspecified
E29898Medicare UPIN