Provider Demographics
NPI:1164441572
Name:MILLER, ELLIOT F (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:F
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HOLLISTER DR STE 211
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5266
Mailing Address - Country:US
Mailing Address - Phone:847-816-3084
Mailing Address - Fax:
Practice Address - Street 1:1800 HOLLISTER DR
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5263
Practice Address - Country:US
Practice Address - Phone:847-816-3084
Practice Address - Fax:847-816-0031
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-063303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C40395Medicare UPIN