Provider Demographics
NPI:1346289808
Name:MILLER, JEFF ILWILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:ILWILLIAM
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3017
Mailing Address - Country:US
Mailing Address - Phone:618-345-3367
Mailing Address - Fax:618-345-1251
Practice Address - Street 1:302 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3017
Practice Address - Country:US
Practice Address - Phone:618-345-3367
Practice Address - Fax:618-345-1251
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery