Individual
GLENN MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 MAIN ST, PEORIA, IL 61602-1076
(309) 672-4977
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0001
(309) 672-4809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028606
HEALTH ALLIANCE
IL
05
—
0360696082
—
IL
01
—
472301
HEALTHLINK
IL
01
—
7215059
BCBS PPO
IL
01
—
IL01N2
JOHN DEERE
IL
Enumeration date
08/01/2006
Last updated
07/08/2007
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