Healthcare Provider Details

I. General information

NPI: 1932921988
Provider Name (Legal Business Name): CHARLES E MILLER MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OSLER STE 120
NAPERVILLE IL
60540-7429
US

IV. Provider business mailing address

9380 STATION ST STE 425
LONE TREE CO
80124-6832
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DIANE JEAN RAVECH
Title or Position: CHIEF MANAGED CARE OFFICER
Credential:
Phone: 860-305-6640