Healthcare Provider Details

I. General information

NPI: 1861078867
Provider Name (Legal Business Name): PARKER ALEXANDER MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S WOOD ST STE 471
CHICAGO IL
60612-7300
US

IV. Provider business mailing address

808 S WOOD ST STE 471
CHICAGO IL
60612-7300
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-7480
  • Fax:
Mailing address:
  • Phone: 312-413-7480
  • 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 Code207P00000X
TaxonomyEmergency Medicine Physician
License Number288716
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.173424
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: