1902855364 NPI number — DR. PATRICIA LYNN MILLER PHD

Table of content: BERENICE TORRES (NPI 1578910675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902855364 NPI number — DR. PATRICIA LYNN MILLER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
PATRICIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902855364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 HOUBOLT ROAD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60431-8305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-841-1555
Provider Business Mailing Address Fax Number:
815-741-1555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 HOUBOLT ROAD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60431-8305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-841-1555
Provider Business Practice Location Address Fax Number:
815-741-1555
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  071002555 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 81604 . This is a "CONNECTICUT GENERAL LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7576510 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9972011 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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