Provider Demographics
NPI:1295990414
Name:MILLER, STEPHEN E (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2345 W LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-8012
Mailing Address - Country:US
Mailing Address - Phone:765-455-4075
Mailing Address - Fax:765-455-4094
Practice Address - Street 1:2345 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-8012
Practice Address - Country:US
Practice Address - Phone:765-455-4075
Practice Address - Fax:765-455-4094
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004235208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1295990414OtherNPI