Provider Demographics
NPI:1326265976
Name:GAIL D. MILLER MDSC
Entity Type:Organization
Organization Name:GAIL D. MILLER MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-430-2020
Mailing Address - Street 1:9944 - S. ROBERTS ROAD
Mailing Address - Street 2:STE 107
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1555
Mailing Address - Country:US
Mailing Address - Phone:708-430-2020
Mailing Address - Fax:708-430-2142
Practice Address - Street 1:9944 - S. ROBERTS ROAD
Practice Address - Street 2:STE 107
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1555
Practice Address - Country:US
Practice Address - Phone:708-430-2020
Practice Address - Fax:708-430-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360562923174400000X
IL036-056923207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056923Medicaid
IL001651212Medicaid
IL036056923Medicaid
ILIL6512Medicare PIN
ILD14240Medicare UPIN