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: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N KNOXVILLE AVE
PEORIA IL
61614-2017
US

IV. Provider business mailing address

7301 N KNOXVILLE AVE
PEORIA IL
61614-2017
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: