Provider Demographics
NPI:1114010097
Name:MILLER, CHARLES EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 OSLER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7429
Mailing Address - Country:US
Mailing Address - Phone:630-428-2229
Mailing Address - Fax:630-428-0336
Practice Address - Street 1:120 OSLER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7429
Practice Address - Country:US
Practice Address - Phone:630-428-2229
Practice Address - Fax:630-428-0336
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066686207VE0102X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2233275OtherBCBS OF IL
E11107Medicare UPIN