Provider Demographics
NPI:1497763429
Name:MILLER, JEAN F (MD)
Entity Type:Individual
Prefix:MISS
First Name:JEAN
Middle Name:F
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1200 N EAST ST
Mailing Address - Street 2:WEBER MEDICAL CLINIC LTD
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2499
Mailing Address - Country:US
Mailing Address - Phone:618-395-5222
Mailing Address - Fax:618-395-8552
Practice Address - Street 1:1200 N EAST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2499
Practice Address - Country:US
Practice Address - Phone:618-395-5222
Practice Address - Fax:618-395-8552
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL119391OtherHEALTHLINK
IL067209OtherHEALTH ALLIANCE
C37431Medicare UPIN
IL067209OtherHEALTH ALLIANCE