Provider Demographics
NPI:1558359570
Name:MILLER, KEITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1155 W JEFFERSON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2730
Mailing Address - Country:US
Mailing Address - Phone:317-346-3100
Mailing Address - Fax:317-346-3660
Practice Address - Street 1:1155 W JEFFERSON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2730
Practice Address - Country:US
Practice Address - Phone:317-346-3100
Practice Address - Fax:317-346-3660
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01033799A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE42531Medicare UPIN
IN191310AMedicare ID - Type Unspecified