Provider Demographics
NPI:1699791640
Name:MILLER, JOYCE REGINA (MD)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:REGINA
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:47 W POLK
Mailing Address - Street 2:SUITE 100-258
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605
Mailing Address - Country:US
Mailing Address - Phone:312-804-6453
Mailing Address - Fax:773-731-9695
Practice Address - Street 1:47 W POLK
Practice Address - Street 2:SUITE 100-258
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605
Practice Address - Country:US
Practice Address - Phone:312-804-6453
Practice Address - Fax:773-731-9695
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360809832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036080983Medicaid
K08722Medicare UPIN