MEDICARE: MICHAEL S. MILLER DO, FACOS, CWS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	02001905	IN
2	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316072242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL S. MILLER DO, FACOS, CWS, PC

Provider Business Mailing Address
First Line	:	3850 SHORE DR STE 315
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4693
Country	:	US
Telephone Number	:	317-491-0061
Fax Number	:	317-222-1953

Provider Business Practice Location Address
First Line	:	3850 SHORE DR STE 315
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4693
Country	:	US
Telephone Number	:	317-429-0061
Fax Number	:	317-222-1953

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL SETH MILLER
Credential	:	DO
Telephone Number	:	317-429-0061

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	03/05/2023

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