Healthcare Provider Details

I. General information

NPI: 1972630796
Provider Name (Legal Business Name): DEANNE LEE MILLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 05/25/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 ALFT LN STE 100
ELGIN IL
60124-8090
US

IV. Provider business mailing address

2410 ALFT LN STE 100
ELGIN IL
60124-8090
US

V. Phone/Fax

Practice location:
  • Phone: 847-531-4883
  • Fax: 847-478-3229
Mailing address:
  • Phone: 847-531-4883
  • Fax: 847-478-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036116732
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-116732
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: