Provider Demographics
NPI:1730298886
Name:MILLER, JAMES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:610 S MAPLE AVE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1091
Mailing Address - Country:US
Mailing Address - Phone:708-848-7673
Mailing Address - Fax:708-848-5270
Practice Address - Street 1:610 S MAPLE AVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1091
Practice Address - Country:US
Practice Address - Phone:708-848-7673
Practice Address - Fax:708-848-5270
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-056253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056253Medicaid
IL036056253Medicaid
D13914Medicare UPIN