Healthcare Provider Details

I. General information

NPI: 1639203516
Provider Name (Legal Business Name): CHARLES E MILLER M D SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PAM DAVIS DRIVE SUITE 100
NAPERVILLE IL
60540
US

IV. Provider business mailing address

120 PAM DAVIS DRIVE SUITE 100
NAPERVILLE IL
60540
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-2229
  • Fax:
Mailing address:
  • Phone: 630-428-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATT TYSON
Title or Position: DIRECTOR, MANAGED CARE CONTRACTING
Credential:
Phone: 615-477-6677