Provider Demographics
NPI:1184786535
Name:MILLER, JEFFREY S (DN)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5979
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-5979
Mailing Address - Country:US
Mailing Address - Phone:847-897-5995
Mailing Address - Fax:847-897-5990
Practice Address - Street 1:707 LAKE COOK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5613
Practice Address - Country:US
Practice Address - Phone:847-498-3736
Practice Address - Fax:847-509-1589
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004926183OtherBCBS