Provider Demographics
NPI:1750892923
Name:MILLER, ALBAN INGRAM JR
Entity type:Individual
Prefix:DR
First Name:ALBAN
Middle Name:INGRAM
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 FOXBOROUGH CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-8503
Mailing Address - Country:US
Mailing Address - Phone:217-369-9395
Mailing Address - Fax:
Practice Address - Street 1:1708 FOXBOROUGH CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-8503
Practice Address - Country:US
Practice Address - Phone:217-369-9395
Practice Address - Fax:217-369-9395
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.0791262086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty