MEDICARE: RONALD 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	174400000X	Specialist	036060611	IL

General Provider Information

NPI Number	:	1841280831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD MILLER M.D.

Provider Business Mailing Address
First Line	:	220 RICHMOND AVE E
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-4652
Country	:	US
Telephone Number	:	217-234-3937
Fax Number	:	217-234-3930

Provider Business Practice Location Address
First Line	:	220 RICHMOND AVE E
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-4652
Country	:	US
Telephone Number	:	217-234-3937
Fax Number	:	217-234-3930

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	02/13/2012

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