Provider Demographics
NPI:1528359106
Name:MILLER, MARK DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DANIEL
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:420 NE GLEN OAK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3170
Mailing Address - Country:US
Mailing Address - Phone:309-453-4447
Mailing Address - Fax:309-655-4147
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-4699
Practice Address - Country:US
Practice Address - Phone:309-624-9844
Practice Address - Fax:309-655-4147
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2018-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.1438092080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology