Healthcare Provider Details

I. General information

NPI: 1770656332
Provider Name (Legal Business Name): DAVID C MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 LANDMARK DR STE A
LAFAYETTE IN
47905
US

IV. Provider business mailing address

8805 N MERIDIAN ST STE 100
INDIANAPOLIS IN
46260-2643
US

V. Phone/Fax

Practice location:
  • Phone: 765-807-2780
  • Fax: 765-807-2781
Mailing address:
  • Phone: 317-706-7246
  • Fax: 317-818-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number01035762
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01035762A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: