Healthcare Provider Details

I. General information

NPI: 1225114663
Provider Name (Legal Business Name): JOSHUA DEVEREUX MILLER MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RIVERSIDE DR STE 1600
BOURBONNAIS IL
60914-5406
US

IV. Provider business mailing address

400 RIVERSIDE DR STE 1600
BOURBONNAIS IL
60914-5406
US

V. Phone/Fax

Practice location:
  • Phone: 815-802-7090
  • Fax: 815-802-7091
Mailing address:
  • Phone: 815-802-7090
  • Fax: 815-802-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301066073
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036147403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: