Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 19A13885 | IL |
NPI | 1306820659 |
---|---|
Provider Name | Dr. Stephen Andrew Miller |
First Address | Metropolis, IL 62960-2810 |
Second Address | Metropolis, IL 62960-2810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/07/2007 |