Provider Demographics
NPI:1386725638
Name:MILLER, THOMAS WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
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 775985
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5985
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:205 NOBLE CREEK DR
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3117
Practice Address - Country:US
Practice Address - Phone:317-773-8483
Practice Address - Fax:317-776-0442
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033800A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100238140AMedicaid
IN000000086709OtherANTHEM
IN826040Medicare PIN
IN100238140AMedicaid
IN177280041Medicare PIN