Provider Demographics
NPI:1740815885
Name:MILES, CANDICE MARIE (RVT, RDCS, ARDMS, RT)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:MILES
Suffix:
Gender:F
Credentials:RVT, RDCS, ARDMS, RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CONESTOGA DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1559
Mailing Address - Country:US
Mailing Address - Phone:219-617-8218
Mailing Address - Fax:502-775-8345
Practice Address - Street 1:475 BROWN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2325
Practice Address - Country:US
Practice Address - Phone:815-937-7962
Practice Address - Fax:815-936-8650
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5360024302172A00000X
IN98113174H00000X, 207V00000X, 208000000X, 247100000X, 2471C1101X, 2471S1302X, 2471V0105X, 335V00000X, 2085U0001X, 2471V0105X, 335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No174H00000XOther Service ProvidersHealth Educator
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier