Healthcare Provider Details

I. General information

NPI: 1508894585
Provider Name (Legal Business Name): MARK MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/26/2021
Certification Date: 12/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GRAND CANYON PKWY STE 301
HOFFMAN ESTATES IL
60169-1732
US

IV. Provider business mailing address

1000 GRAND CANYON PKWY STE 301
HOFFMAN ESTATES IL
60169-1732
US

V. Phone/Fax

Practice location:
  • Phone: 847-352-2822
  • Fax:
Mailing address:
  • Phone: 847-352-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number036080141
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: