| Doctor Name: | MR. MARK ANDREW MILLER |
| NPI Number: | 1891909750 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PENDING |
| Business Practice Address: | 236 W Edison Rd Suite F Mishawaka, IN - 465453184 |
| Business Phone Number: | 5742551290 |
| Business Fax Number: | 5742551523 |
| Mailing Address: | 14630 Tranquil Ct, GRANGER |
| State: | IN |
| Postal Code: | 465308301 |
| Phone Number: | 5742551290 |
| Fax Number: | 5742551523 |
| NPI Enumeration Date: | 05/10/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | PENDING |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |