Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 01065478A | IN |
NPI | 1275791469 |
---|---|
Provider Name | Justin Wayne Miller |
First Address | Carmel, IN 46032-5480 |
Second Address | Carmel, IN 46032-5480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2008 |
Last Update Date | 31/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000721077 | ANTHEM (01) | IN |
9072700 | AETNA (01) | IN |