Healthcare Provider Details

I. General information

NPI: 1154557429
Provider Name (Legal Business Name): CHRISTOPHER ALLEN MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 N MILWAUKEE AVE
CHICAGO IL
60647-5453
US

IV. Provider business mailing address

1776 N MILWAUKEE AVE
CHICAGO IL
60647-5453
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3627
  • Fax:
Mailing address:
  • Phone: 312-926-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD77381
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036143872
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number036143872
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036143872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: