Basic Information
| Provider Information | |||||||||
| NPI: | 1114010097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 OSLER DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605407429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304282229 | ||||||||
| FaxNumber: | 6304280336 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 OSLER DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605407429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304282229 | ||||||||
| FaxNumber: | 6304280336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 01/31/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VE0102X | 036066686 | IL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology | 207V00000X | 036066686 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2233275 | 01 | IL | BCBS OF IL | OTHER |