Provider Demographics
NPI:1548528151
Name:MARK DAVID MILLER P. C.
Entity type:Organization
Organization Name:MARK DAVID MILLER P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-773-1981
Mailing Address - Street 1:19905 WINDSOR PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-4328
Mailing Address - Country:US
Mailing Address - Phone:317-557-8987
Mailing Address - Fax:317-773-1781
Practice Address - Street 1:16865 CLOVER RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3640
Practice Address - Country:US
Practice Address - Phone:317-773-1981
Practice Address - Fax:317-773-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002264261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty