Provider Demographics
NPI:1649213695
Name:MILLER, MELISSA E (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2862 W 100 N
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-7856
Mailing Address - Country:US
Mailing Address - Phone:317-326-1221
Mailing Address - Fax:317-326-1805
Practice Address - Street 1:2862 W 100 N
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-7856
Practice Address - Country:US
Practice Address - Phone:317-326-1221
Practice Address - Fax:317-326-1805
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000426A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000384847OtherBC/BS PIN
DD8249OtherRAILROAD GROUP
P00337987OtherRAILROAD MEDICARE PIN
IN000000384847OtherBC/BS PIN
IN232010BMedicare PIN