Provider Demographics
NPI:1225114663
Name:MILLER, JOSHUA DEVEREUX (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DEVEREUX
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RIVERSIDE DR STE 1600
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5406
Mailing Address - Country:US
Mailing Address - Phone:815-802-7090
Mailing Address - Fax:815-802-7091
Practice Address - Street 1:400 RIVERSIDE DR STE 1600
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5406
Practice Address - Country:US
Practice Address - Phone:815-802-7090
Practice Address - Fax:815-802-7091
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066073207X00000X
IL036147403207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036147403Medicaid