Provider Demographics
NPI:1225169774
Name:BURTON MILLER, M.D., S.C.
Entity Type:Organization
Organization Name:BURTON MILLER, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-367-1070
Mailing Address - Street 1:890 S. GARFIELD AVE.
Mailing Address - Street 2:206
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4726
Mailing Address - Country:US
Mailing Address - Phone:847-367-1070
Mailing Address - Fax:847-367-1075
Practice Address - Street 1:890 GARFIELD AVE
Practice Address - Street 2:206
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-4723
Practice Address - Country:US
Practice Address - Phone:847-367-1070
Practice Address - Fax:847-367-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.003534036.041206208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty