Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 096004449 | IL |
N | 204C00000X | Sports Medicine Doctor | 2016030518 | MO |
NPI | 1245898857 |
---|---|
Provider Name | Catherine Miller |
First Address | Naperville, IL 60564-4745 |
Second Address | Oak Brook, IL 60523-8813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2019 |
Last Update Date | 31/05/2019 |