Provider Demographics
NPI:1861593055
Name:MILLER, MICHELLE D (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N RITTER AVE STE 375
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3049
Practice Address - Country:US
Practice Address - Phone:317-355-9370
Practice Address - Fax:317-621-5678
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01062652A207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01212110OtherRR MEDICARE PTAN
INP01197282OtherRR MEDICARE PTAN
IN200894810Medicaid
INP01212110OtherRR MEDICARE PTAN
IN266180204Medicare PIN
IN715530CRRRMedicare PIN