Provider Demographics
NPI:1063591808
Name:MILLAR, MARTHA LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:LOUISE
Last Name:MILLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCY
Other - Middle Name:
Other - Last Name:MILLAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2501 COMPASS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8000
Mailing Address - Country:US
Mailing Address - Phone:847-901-5200
Mailing Address - Fax:847-904-4905
Practice Address - Street 1:2501 COMPASS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8000
Practice Address - Country:US
Practice Address - Phone:847-901-5200
Practice Address - Fax:847-904-4905
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-078461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
216024OtherGROUP PTAN
1912186024OtherGROUP NPI
ILE30990Medicare UPIN
IL903270Medicare ID - Type Unspecified
K48464Medicare PIN