Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036123296 | IL |
NPI | 1093901886 |
---|---|
Provider Name | Matthew David Miller |
First Address | Westchester, IL 60154-5701 |
Second Address | Winfield, IL 60190-1222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2007 |
Last Update Date | 12/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1633878 | BCBS (01) | IL |
207067007 (207067) | (02) | IL |
207073007 (207073) | (02) | IL |
9271390 | AETNA (01) | IL |