MEDICARE: DAVID L MILLER D.O.

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	207R00000X	Internal Medicine Physician	036104354	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110247080	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5532005	OTHER	IL	BLUE CROSS/BLUE SHIELD
4	067033	OTHER	IL	HEALTH ALLIANCE

General Provider Information

NPI Number	:	1861497612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L MILLER D.O.

Provider Business Mailing Address
First Line	:	PO BOX 556
Second Line	:
City	:	MACOMB
State	:	IL
Zip	:	61455-0556
Country	:	US
Telephone Number	:	309-833-2868
Fax Number	:	309-836-3779

Provider Business Practice Location Address
First Line	:	505 E GRANT ST
Second Line	:	STE 103
City	:	MACOMB
State	:	IL
Zip	:	61455-3352
Country	:	US
Telephone Number	:	309-833-3536
Fax Number	:	309-836-5729

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	11/10/2011

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Directions to “ DAVID L MILLER D.O.” Practice Location

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