Provider Demographics
NPI:1568555084
Name:MILLER MEDICAL, INC
Entity Type:Organization
Organization Name:MILLER MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J. DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BESHOAR
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:847-359-4642
Mailing Address - Street 1:3257 N. RIDGE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004
Mailing Address - Country:US
Mailing Address - Phone:847-537-2730
Mailing Address - Fax:847-537-6701
Practice Address - Street 1:3257 N. RIDGE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-537-2730
Practice Address - Fax:847-537-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04520397OtherBC/BS IL PROV #
IL=========0001Medicaid
IL=========0001Medicaid