Healthcare Provider Details

I. General information

NPI: 1326048802
Provider Name (Legal Business Name): THOMAS LEE MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W MAUMEE ST
ANGOLA IN
46703-8605
US

IV. Provider business mailing address

1500 W MAUMEE ST
ANGOLA IN
46703-8605
US

V. Phone/Fax

Practice location:
  • Phone: 260-665-8494
  • Fax: 260-668-5690
Mailing address:
  • Phone: 260-665-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number200185720A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01033506A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: