Provider Demographics
NPI:1447728951
Name:MILLER, MATTHEW DAVID (PA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5369 E 50 S
Mailing Address - Street 2:
Mailing Address - City:LAGRO
Mailing Address - State:IN
Mailing Address - Zip Code:46941-9434
Mailing Address - Country:US
Mailing Address - Phone:260-403-1980
Mailing Address - Fax:
Practice Address - Street 1:5369 E 50 S
Practice Address - Street 2:
Practice Address - City:LAGRO
Practice Address - State:IN
Practice Address - Zip Code:46941-9434
Practice Address - Country:US
Practice Address - Phone:260-403-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program