Provider Demographics
NPI:1558586776
Name:MILLER, WAYNE STARR (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:STARR
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 1:7735 E MANITOU TRL-92 # 92
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:IN
Mailing Address - Zip Code:46783-9203
Mailing Address - Country:US
Mailing Address - Phone:260-672-3592
Mailing Address - Fax:
Practice Address - Street 1:7735 E MANITOU TRL-92
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:IN
Practice Address - Zip Code:46783-9203
Practice Address - Country:US
Practice Address - Phone:260-672-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01018090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01018090OtherLICENSE NUMBER