Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036080141 | IL |
NPI | 1508894585 |
---|---|
Provider Name | Mark Miller |
First Address | Hoffman Estates, IL 60169-1732 |
Second Address | Hoffman Estates, IL 60169-1732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 26/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036080141 | (05) | IL |