Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | IN08000569 | IN |
NPI | 1316995756 |
---|---|
Provider Name | Dr. Norman Miller |
First Address | Middlebury, IN 46540-9701 |
Second Address | Middlebury, IN 46540-9701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 24/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U22041 | (02) | IN |