Provider Demographics
NPI:1902835226
Name:MILLER, ROBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3331 W DEYOUNG ST
Mailing Address - Street 2:STE 109
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5896
Mailing Address - Country:US
Mailing Address - Phone:618-998-7239
Mailing Address - Fax:618-998-7248
Practice Address - Street 1:3331 W DEYOUNG ST
Practice Address - Street 2:STE 109
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5896
Practice Address - Country:US
Practice Address - Phone:618-998-7239
Practice Address - Fax:618-998-7248
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-085262208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085262Medicaid
A47915Medicare UPIN
ILK26231Medicare ID - Type Unspecified