Provider Demographics
NPI:1417937004
Name:MILLER, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(1211 ROOSEVELT RD., MAYWOOD, IL. 60153)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-531-5200
Mailing Address - Fax:708-531-5201
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(1211 ROOSEVELT RD., MAYWOOD, IL. 60153)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-531-5200
Practice Address - Fax:708-531-5201
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36103949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36103949Medicaid
ILK08371Medicare ID - Type Unspecified
ILK08370Medicare ID - Type Unspecified
IL36103949Medicaid