Basic Information
| Provider Information | |||||||||
| NPI: | 1841280831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 220 RICHMOND AVE E | ||||||||
| Address2: | |||||||||
| City: | MATTOON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619384652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172343937 | ||||||||
| FaxNumber: | 2172343930 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 RICHMOND AVE E | ||||||||
| Address2: | |||||||||
| City: | MATTOON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619384652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172343937 | ||||||||
| FaxNumber: | 2172343930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 02/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 036060611 | IL | Y | Other Service Providers | Specialist |
No ID Information.