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General NPI Number Information
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NPI Number | 1760883441
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Entity Type | Individual
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Provider Name | WILL DANIEL MILLER P.A.
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Gender | Male
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 355 E ASH AVE
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City | DECATUR
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State | IL
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Zip | 62526-6136
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Country | US
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Telephone | 217-450-9826
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Fax | 217-717-2346
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Provider Business Mailing Address
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Address Line | 355 E ASH AVE
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City | DECATUR
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State | IL
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Zip | 62526-6136
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Country | US
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Telephone | 217-450-9826
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Fax | 217-717-2346
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085005212
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License Number State | IL
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