Individual
MICHELLE M MINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 N 9TH ST FL 4, SPRINGFIELD, IL 62702-5310
(217) 545-8000
(217) 545-3971
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-106594
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106594
—
IL
Enumeration date
11/22/2005
Last updated
09/24/2024
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