Individual
WILLIAM M MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 217-3300
(317) 217-3474
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002560A
IN
363AM0700X
Medical Physician Assistant
10002560A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010164
MEDICARE PTAN
IN
05
—
300020207
—
IN
Enumeration date
09/12/2018
Last updated
02/13/2021
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