Healthcare Provider Details

I. General information

NPI: 1639203516
Provider Name (Legal Business Name): CHARLES E MILLER M D SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 EAST GOLF RD. SUITE L125
SCHAUMBURG IL
60173
US

IV. Provider business mailing address

27555 DIEHL RD ENTRANCE B
WARRENVILLE IL
60555-3849
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-1040
  • Fax: 847-517-9294
Mailing address:
  • Phone: 630-646-3884
  • Fax: 630-548-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES E. MILLER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 847-593-1040