MEDICARE: DR. MATTHEW RICHARD MILLS 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	174400000X	Specialist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636672	OTHER	IL	BLUE CROSS, BLUE SHIELD

General Provider Information

NPI Number	:	1437295201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW RICHARD MILLS M.D.

Provider Business Mailing Address
First Line	:	1850 W OAKDALE AVE
Second Line	:	REAR COACH
City	:	CHICAGO
State	:	IL
Zip	:	60657-4024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 N MICHIGAN AVE
Second Line	:	SUITE 1715
City	:	CHICAGO
State	:	IL
Zip	:	60611-3110
Country	:	US
Telephone Number	:	773-938-1595
Fax Number	:	312-277-2530

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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