Healthcare Provider Details

I. General information

NPI: 1588658447
Provider Name (Legal Business Name): KIMBERLY M BATTLE-MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY M TRACY M.D.

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HIGHLAND AVE STE 5B
DOWNERS GROVE IL
60515-1551
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 630-963-9963
  • Fax: 630-963-9667
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036089483
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number036089483
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: