MEDICARE: JENNIFER E MILLER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085002629	IL

General Provider Information

NPI Number	:	1083656979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER E MILLER PA

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR STE 1000
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-8709
Country	:	US
Telephone Number	:	312-695-0665
Fax Number	:	312-695-6594

Provider Business Practice Location Address
First Line	:	1704 MAPLE AVE STE 100
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-3134
Country	:	US
Telephone Number	:	312-694-2273
Fax Number	:	312-694-2299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	04/04/2018

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Directions to “ JENNIFER E MILLER PA” Practice Location

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