Provider Demographics
NPI:1740274992
Name:MILLER, MAUDIE M (MD)
Entity type:Individual
Prefix:DR
First Name:MAUDIE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5068
Mailing Address - Country:US
Mailing Address - Phone:618-463-8578
Mailing Address - Fax:618-463-8666
Practice Address - Street 1:1 PROFESSIONAL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5068
Practice Address - Country:US
Practice Address - Phone:618-463-8578
Practice Address - Fax:618-463-8666
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery