Healthcare Provider Details

I. General information

NPI: 1568277176
Provider Name (Legal Business Name): MATTHEW J MILLER JR NRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9419 13 1/2 ST W
ROCK ISLAND IL
61201-7804
US

IV. Provider business mailing address

9419 13 1/2 ST W
ROCK ISLAND IL
61201-7804
US

V. Phone/Fax

Practice location:
  • Phone: 563-271-2713
  • Fax:
Mailing address:
  • Phone: 563-271-2713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPARA4001323
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number060847886
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: