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Organization
MEDICAL GROUP OF MACOMB, LLC
Active
Organization
MEDICAL GROUP OF MACOMB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID MILLER D.O. (PRESIDENT)
(309) 833-3536
Entity
Organization
Contact information
Practice address
505 E GRANT ST STE 103, MACOMB, IL 61455-3308
(309) 833-3536
(309) 836-5729
Mailing address
PO BOX 556, MACOMB, IL 61455-0556
(309) 833-3536
(309) 836-5729
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
208000000X
Pediatrics Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104354
—
IL
05
—
036111319
—
IL
01
—
067033
HEALTH ALLIANCE
IL
01
—
095260
HEALTH ALLIANCE
IL
01
—
110247080
RAILROAD MEDICARE
IL
01
—
5532005
BLUE CROSS/BLUE SHIELD IL
IL
01
—
DG6820
RAILROAD MEDICARE
IL
Enumeration date
10/12/2006
Last updated
07/21/2022
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