Healthcare Provider Details

I. General information

NPI: 1508998105
Provider Name (Legal Business Name): RICHARD ANDREW MILLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N KNOXVILLE AVE
PEORIA IL
61614-2017
US

IV. Provider business mailing address

8600 N. STATE RT 91 SUITE 300
PEORIA IL
61615-7832
US

V. Phone/Fax

Practice location:
  • Phone: 309-589-5900
  • Fax: 309-689-0312
Mailing address:
  • Phone: 309-691-6616
  • Fax: 309-691-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001469
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085001469
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: