Healthcare Provider Details

I. General information

NPI: 1619888476
Provider Name (Legal Business Name): SEAN MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5147
US

IV. Provider business mailing address

420 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5147
US

V. Phone/Fax

Practice location:
  • Phone: 317-850-4908
  • Fax:
Mailing address:
  • Phone: 317-850-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28278747C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: