MEDICARE: DR. CHARLES EDWARD MILLER M.D.

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	207VE0102X	Reproductive Endocrinology Physician	036066686	IL
2	207V00000X	Obstetrics & Gynecology Physician	036066686	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2233275	OTHER	IL	BCBS OF IL

General Provider Information

NPI Number	:	1114010097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES EDWARD MILLER M.D.

Provider Business Mailing Address
First Line	:	120 PAM DAVIS DRIVE
Second Line	:	SUITE 100
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-7429
Country	:	US
Telephone Number	:	630-428-2229
Fax Number	:	630-428-0336

Provider Business Practice Location Address
First Line	:	120 PAM DAVIS DRIVE
Second Line	:	SUITE 100
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-7429
Country	:	US
Telephone Number	:	630-428-2229
Fax Number	:	630-428-0336

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/20/2026

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