Provider Demographics
NPI:1447237920
Name:MOYE, MILLICENT D (MD)
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:D
Last Name:MOYE
Suffix:
Gender:F
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 637999
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7999
Mailing Address - Country:US
Mailing Address - Phone:317-682-2030
Mailing Address - Fax:317-644-5060
Practice Address - Street 1:640 ESKENAZI AVE
Practice Address - Street 2:F1-200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5173
Practice Address - Country:US
Practice Address - Phone:317-880-6559
Practice Address - Fax:317-880-0411
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059510A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000521092OtherANTHEM
IN100143130AMedicaid
IN000000521092OtherANTHEM
IN466980RMedicare ID - Type Unspecified
IN719300KKMedicare PIN