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General NPI Number Information
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NPI Number | 1326048802
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Entity Type | Individual
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Provider Name | THOMAS LEE MILLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 1500 W MAUMEE ST
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City | ANGOLA
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State | IN
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Zip | 46703-8605
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Country | US
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Telephone | 260-665-8494
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Fax | 260-668-5690
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Provider Business Mailing Address
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Address Line | 1500 W MAUMEE ST
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City | ANGOLA
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State | IN
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Zip | 46703-8605
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Country | US
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Telephone | 260-665-8494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 200185720A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01033506A
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License Number State | IN
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