Healthcare Provider Details

I. General information

NPI: 1891228631
Provider Name (Legal Business Name): MELISSA JOY MILLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2017
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 S LAFOUNTAIN ST
KOKOMO IN
46902-3803
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 765-776-3000
  • Fax:
Mailing address:
  • Phone: 414-805-6850
  • Fax: 414-805-6851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71144
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number71144
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02008429A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: