Provider Demographics
NPI:1669606281
Name:MILLER, KIMBERLY ANNE (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:STANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1941 ROHLWING RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1338
Mailing Address - Country:US
Mailing Address - Phone:847-618-0850
Mailing Address - Fax:847-618-0859
Practice Address - Street 1:1941 ROHLWING RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1338
Practice Address - Country:US
Practice Address - Phone:847-618-0850
Practice Address - Fax:847-618-0859
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130422OtherSTATE LICENSE