Healthcare Provider Details

I. General information

NPI: 1427050988
Provider Name (Legal Business Name): MARVIN JAY MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10765 LANTERN RD SUITE 102
FISHERS IN
46038-3597
US

IV. Provider business mailing address

10765 LANTERN RD SUITE 102
FISHERS IN
46038-3597
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-4181
  • Fax: 317-621-4182
Mailing address:
  • Phone: 317-621-4181
  • Fax: 317-621-4182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01024897A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: