Basic Information
| Provider Information | |||||||||
| NPI: | 1770656332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8805 N MERIDIAN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462602643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177067246 | ||||||||
| FaxNumber: | 3178180929 | ||||||||
| Practice Location | |||||||||
| Address1: | 3738 LANDMARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7658072780 | ||||||||
| FaxNumber: | 7658072781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 01035762 | IN | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207LP2900X | 01035762A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000779298 | 01 | IN | ANTHEM BCBS | OTHER | 100352730 | 05 | IN | MEDICAID | 200149800A | 05 | IN | MEDICAID |