Provider Demographics
NPI:1669489712
Name:KIMBERLY BATTLE-MILLER, MD, SC
Entity Type:Organization
Organization Name:KIMBERLY BATTLE-MILLER, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTLE-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-932-9351
Mailing Address - Street 1:15774 S LA GRANGE RD
Mailing Address - Street 2:#229
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4766
Mailing Address - Country:US
Mailing Address - Phone:773-767-3822
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:15774 S LA GRANGE RD
Practice Address - Street 2:#229
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4766
Practice Address - Country:US
Practice Address - Phone:773-767-3822
Practice Address - Fax:773-767-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635624OtherBC/BS PROVIDER #
IL212513Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #
ILK22280Medicare ID - Type UnspecifiedIND MEDICARE PROV #
ILH69889Medicare UPIN