Healthcare Provider Details

I. General information

NPI: 1750382396
Provider Name (Legal Business Name): RODNEY LEE MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S PARK AVE 3RD FLOOR
HERRIN IL
62948-3612
US

IV. Provider business mailing address

1239 E MAIN ST P O BOX 3988
CARBONDALE IL
62901-3114
US

V. Phone/Fax

Practice location:
  • Phone: 618-942-2002
  • Fax: 618-942-4477
Mailing address:
  • Phone: 618-457-5200
  • Fax: 618-351-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-106959
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036106959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: