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General NPI Number Information
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NPI Number | 1376571265
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Entity Type | Individual
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Provider Name | CRAIG B MILLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 2349 LAKE AVE STE 100
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City | PLYMOUTH
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State | IN
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Zip | 46563-7836
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Country | US
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Telephone | 574-948-5100
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Fax | 574-948-5499
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Provider Business Mailing Address
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Address Line | 707 CEDAR ST STE 405
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City | SOUTH BEND
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State | IN
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Zip | 46617-2059
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Country | US
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Telephone | 574-335-8707
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Fax | 574-335-8741
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01050910
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License Number State | IN
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