Healthcare Provider Details

I. General information

NPI: 1598180135
Provider Name (Legal Business Name): CHRIS E. MILEOS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 STATE ROUTE 91 STE 250
PEORIA IL
61615-7831
US

IV. Provider business mailing address

8600 STATE ROUTE 91 STE 250
PEORIA IL
61615-7831
US

V. Phone/Fax

Practice location:
  • Phone: 309-621-7001
  • Fax: 309-692-2538
Mailing address:
  • Phone: 309-621-7001
  • Fax: 309-692-2538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209-011269
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: