Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 07000378A | IN |
N | 222Z00000X | Podiatrist | 07000378A | IN |
N | 213EP1101X | Primary Podiatric Medicine | 07000378A | IN |
N | 213ES0131X | Foot Surgery | 07000378A | IN |
NPI | 1477556140 |
---|---|
Provider Name | Dr. John S Miles |
First Address | Peru, IN 46970-2637 |
Second Address | Peru, IN 46970-2637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000174145 | ANTHEM (01) | IN |
T34657 | (02) | IN |