Provider Demographics
NPI:1477556140
Name:MILES, JOHN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:MILES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-2637
Mailing Address - Country:US
Mailing Address - Phone:765-472-4930
Mailing Address - Fax:765-472-4330
Practice Address - Street 1:685 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-2637
Practice Address - Country:US
Practice Address - Phone:765-472-4930
Practice Address - Fax:765-472-4330
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000378A213E00000X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000174145OtherANTHEM
INT34657Medicare UPIN
IN292520Medicare ID - Type Unspecified