Provider Demographics
NPI:1588658447
Name:BATTLE-MILLER, KIMBERLY M (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:M
Last Name:BATTLE-MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:3825 HIGHLAND AVE STE 5B
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1551
Practice Address - Country:US
Practice Address - Phone:630-963-9963
Practice Address - Fax:630-963-9667
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089483174400000X, 2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635624OtherBCBS PROVIDER NUMBER
ILF400192396OtherMEDICARE PTAN (INDIVIDUAL)
IL036089483OtherLICENSE #
IL036089483Medicaid
IL206147OtherMEDICARE PTAN (GROUP)
IL036089483Medicaid
ILH69889Medicare UPIN