Provider Demographics
NPI:1235545047
Name:MILLER, JOSEPH LEON
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEON
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8912 EWING AVE
Mailing Address - Street 2:#2
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1900
Mailing Address - Country:US
Mailing Address - Phone:612-616-0108
Mailing Address - Fax:
Practice Address - Street 1:240 SAUNDERS RD
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3835
Practice Address - Country:US
Practice Address - Phone:612-616-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.006327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist