Provider Demographics
NPI:1225001688
Name:MILLER, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47730-3089
Mailing Address - Country:US
Mailing Address - Phone:812-471-1200
Mailing Address - Fax:812-475-6700
Practice Address - Street 1:3699 EPWORTH RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8909
Practice Address - Country:US
Practice Address - Phone:812-471-1200
Practice Address - Fax:812-475-6700
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010369892085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01Medicaid
IN20044480BMedicaid
IL01Medicaid
INF27151Medicare UPIN