Provider Demographics
NPI:1730122268
Name:MILLER, MICHAEL SETH (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SETH
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 SHORE DR
Mailing Address - Street 2:STE 315
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4693
Mailing Address - Country:US
Mailing Address - Phone:317-429-0061
Mailing Address - Fax:317-222-1953
Practice Address - Street 1:3850 SHORE DR
Practice Address - Street 2:STE 315
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4693
Practice Address - Country:US
Practice Address - Phone:317-429-0061
Practice Address - Fax:317-222-1953
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001905A207RA0401X, 2086H0002X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200044490AMedicaid
IN195650Medicare ID - Type Unspecified
IN200044490AMedicaid