Basic Information
| Provider Information | |||||||||
| NPI: | 1710908389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | ROGER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 E COUNTY ROAD 400 N | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473039579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652890992 | ||||||||
| FaxNumber: | 7652890992 | ||||||||
| Practice Location | |||||||||
| Address1: | 3911 W CLARA LN | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473045412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652888800 | ||||||||
| FaxNumber: | 7657512278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 06/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01023368 | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.