MEDICARE: DR. JACOB NATHANIEL MILLER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0205X	Pediatric Endocrinology Physician	036.163453	IL
2	390200000X	Student in an Organized Health Care Education/Training Program	036.163453	IL
3	208000000X	Pediatrics Physician	OS025690	PA
4	208000000X	Pediatrics Physician	036.163453	IL
5	2080P0205X	Pediatric Endocrinology Physician	OS025690	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WETBJ	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154881282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB NATHANIEL MILLER DO

Provider Business Mailing Address
First Line	:	420 E SUPERIOR ST STE 9-900
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4494
Country	:	US
Telephone Number	:	312-503-7975
Fax Number	:	312-503-5230

Provider Business Practice Location Address
First Line	:	225 E CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2991
Country	:	US
Telephone Number	:	312-227-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2019
Last Update Date	:	06/05/2026

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Directions to “ DR. JACOB NATHANIEL MILLER DO” Practice Location

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