Healthcare Provider Details

I. General information

NPI: 1962844928
Provider Name (Legal Business Name): AARON JACOB MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE RM. S323, MC 3083
CHICAGO IL
60637-1470
US

IV. Provider business mailing address

5841 S MARYLAND AVE RM. S323, MC 3083
CHICAGO IL
60637-1470
US

V. Phone/Fax

Practice location:
  • Phone: 970-219-4514
  • Fax:
Mailing address:
  • Phone: 970-219-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number125063217
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number125063217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: