Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 036054933 | IL |
NPI | 1578576724 |
---|---|
Provider Name | Michael L Miller |
First Address | Chicago, IL 60611 |
Second Address | Chicago, IL 60611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 07/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036054933 | (05) | IL |
D97557 | (02) |