Provider Demographics
NPI:1497702013
Name:VASCULAR SURGERY OF KOKOMO, PC
Entity Type:Organization
Organization Name:VASCULAR SURGERY OF KOKOMO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-236-8750
Mailing Address - Street 1:305 S BERKLEY RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-5114
Mailing Address - Country:US
Mailing Address - Phone:765-236-8750
Mailing Address - Fax:765-236-8760
Practice Address - Street 1:305 S BERKLEY RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5114
Practice Address - Country:US
Practice Address - Phone:765-236-8750
Practice Address - Fax:765-236-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058152A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN229000Medicare ID - Type UnspecifiedMEDICARE