Provider Demographics
NPI:1427050988
Name:MILLER, MARVIN JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:JAY
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 1:10765 LANTERN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3597
Mailing Address - Country:US
Mailing Address - Phone:317-621-4181
Mailing Address - Fax:317-621-4182
Practice Address - Street 1:10765 LANTERN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3597
Practice Address - Country:US
Practice Address - Phone:317-621-4181
Practice Address - Fax:317-621-4182
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024897A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2191038OtherCIGNA
IN200931580AMedicaid
IND03211OtherMEDICARE RR
IN7177448OtherAETNA
IN000000716275OtherANTHEM
IN200104350Medicaid
IND03211OtherMEDICARE RR
INM400049752Medicare PIN
IN258800CMedicare PIN