DR. MARK DANIEL MILLER (NPI# 1528359106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528359106 |
| Entity Type | Individual |
| Full Name | DR. MARK DANIEL MILLER |
| Credential | M.D. |
| Practice Address |
530 Ne Glen Oak Ave Peoria IL 61637-4699 |
| Mailing Address |
420 Ne Glen Oak Ave Ste 201 Peoria IL 61603-3170 |
| Practice Telephone | 3096249844 |
| Practice Fax Number | 3096554147 |
| Mailing Telephone | 3094534447 |
| Mailing Fax Number | 3096554147 |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2018-03-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0205X |
Pediatrics Specialization: Pediatric Endocrinology |
036.143809 | IL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932731692 | Mark A Miller | Pharmacist | 5431 Sw 35th Dr Ste 200, Gainesville, FL 32608-5277 | 2020-02-10 |
| 1386111250 | Mark Miller | Counselor | 3605 Calumet St, Philadelphia, PA 19129-1603 | 2018-10-30 |
| 1386124873 | Mark E Miller | Dentist | 558 E Bay Ave, Manahawkin, NJ 08050-3340 | 2018-08-15 |
| 1326536335 | Mark Jay Miller | Technician/Technologist | 3617 Sipler Ln, Huntingdon Valley, PA 19006-3223 | 2018-04-25 |
| 1801264148 | Mark J Miller | Counselor | 4141 Highway 11, Rising Fawn, GA 30738-4633 | 2015-09-03 |
| 1427317197 | Mark Anthony Miller | Physical Therapist | 537 West Main St, Brewster, WA 98812-1200 | 2012-05-15 |
| 1790044428 | Mark Ian Miller | Student in an Organized Health Care Education/Training Program | 843 S Sierra Bonita Ave, Los Angeles, CA 90036-4703 | 2012-05-15 |
| 1023384989 | Mark H Miller | Internal Medicine | 6318 17th Ave Ne, Seattle, WA 98115-6809 | 2012-03-26 |
| 1649578816 | Mark A Miller | Pharmacist | 8 Elk Plz, Elkview, WV 25071-9602 | 2011-03-11 |
| 1538399753 | Mark E Miller | Social Worker | 645 S 5th St, Montrose, CO 81401-5710 | 2009-07-22 |
| Street Address |
530 NE GLEN OAK AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61637-4699 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346235777 | Jack Michael Gibson | Obstetrics & Gynecology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-09-12 |
| 1053912188 | Janie Clary | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-11-04 |
| 1265030548 | Christina David | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-10-09 |
| 1033726831 | Corry Lynn Rediger | Occupational Therapist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-25 |
| 1720694094 | Katelynn M Madden | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-21 |
| 1568074474 | Amanda Diane Beoletto | Pharmacist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-08-21 |
| 1881212892 | Mohammad Mousbah Al-tabbaa | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1750909693 | Mohammad Gareeb | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1376160846 | Bassel Elia Abouzeid | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2020-07-01 |
| 1700403516 | Christina Marie Spurgeon | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-06-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
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| Taxonomy Code | 2080P0205X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Endocrinology |
| A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710955885 | Sue E Sauder | Pediatrics | 507 E Armstrong, Regional Development Center, Peoria, IL 61603 | 2006-03-14 |
| 1043487192 | Valeria Claudia Benavides Lopez | Pediatrics | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2008-05-08 |
| 1982816237 | Anu Vishwanath | Pediatrics | 420 Ne Glen Oak Ave Ste 401, Suite 401, Peoria, IL 61603-3168 | 2007-05-07 |
| 1366497539 | Michael Torchinsky | Pediatrics | 530 Ne Glen Oak Ave, Department of Pediatrics, Uic, Peoria, IL 61637 | 2006-05-24 |
| 1073582870 | Joyce Wise | Pediatrics | 507 E Armstrong, Regional Development Center, Peoria, IL 61603 | 2006-03-15 |
| 1114996014 | William Maurer | Pediatrics | Regional Development Center, 507 E Armstrong, Peoria, IL 61603 | 2006-03-15 |
| 1336114636 | Rodney Lorenz | Pediatrics | 507 E Armstrong Ave, Regional Development Center, Peoria, IL 61603-3201 | 2006-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396163671 | Mary Mccauley | Pediatrics | 5841 S Maryland Ave # Mc5053, Chicago, IL 60637-1447 | 2014-04-02 |
| 1891137394 | Ahmed Mohamed Torky | Pediatrics | 301 N 8th St Ste 3a169, Springfield, IL 62701-1041 | 2013-07-24 |
| 1790068872 | Stuart Roy Kupfer | Pediatrics | 1 Takeda Pkwy, Deerfield, IL 60015-5713 | 2011-09-24 |
| 1780983163 | Magdalena Dumin | Pediatrics | 1675 Dempster St Fl 2, Park Ridge, IL 60068 | 2011-03-24 |
| 1447261524 | Jennifer Lynn Miller | Pediatrics | 6501 S Promontory Dr, Chicago, IL 60649-1003 | 2006-08-11 |
| 1962939579 | Apoorva Aekka | Pediatrics | 225 E Chicago Ave # 54, Chicago, IL 60611-2991 | 2017-05-12 |
| 1659740033 | Presence Hospitals Prv | Pediatrics | 301 Madison St, Suite 302, Joliet, IL 60435-6549 | 2015-09-16 |
| 1891058830 | Michelle Blanco Lemelman | Pediatrics | 5841 S Maryland Ave, Chicago, IL 60637-1447 | 2012-06-22 |
| 1760768121 | Adventist Health Partners, Inc | Pediatrics | 12 Salt Creek Ln, Ste 106, Hinsdale, IL 60521-8605 | 2011-10-31 |
| 1972891216 | Juan Jose Lado | Pediatrics | 225 E Chicago Ave, Chicago, IL 60611 | 2011-07-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.