Provider Demographics
NPI:1861683864
Name:MILLER, ROBERT R
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8735 S MERRION LN
Mailing Address - Street 2:
Mailing Address - City:HOMETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:60456-1133
Mailing Address - Country:US
Mailing Address - Phone:708-425-1150
Mailing Address - Fax:708-425-9454
Practice Address - Street 1:8735 S MERRION LN
Practice Address - Street 2:
Practice Address - City:HOMETOWN
Practice Address - State:IL
Practice Address - Zip Code:60456-1133
Practice Address - Country:US
Practice Address - Phone:708-425-1150
Practice Address - Fax:708-425-9454
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILO96.0008162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer