Provider Demographics
NPI:1982315297
Name:MILES, TACHANAVIAN J
Entity type:Individual
Prefix:
First Name:TACHANAVIAN
Middle Name:J
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-2751
Mailing Address - Country:US
Mailing Address - Phone:765-810-4713
Mailing Address - Fax:
Practice Address - Street 1:2209 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-2751
Practice Address - Country:US
Practice Address - Phone:765-810-4713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health