Individual
DR. LISA K MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1275 E BELVIDERE RD, SUITE 200, GRAYSLAKE, IL 60030-2082
(847) 918-1462
(847) 968-4311
Mailing address
1275 E BELVIDERE RD, SUITE 200, GRAYSLAKE, IL 60030-2082
(847) 918-1462
(847) 968-4311
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036-059409
IL
2085R0202X
Diagnostic Radiology Physician
48719
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036059409
—
IL
01
—
202926
GROUP PTAN
IL
01
—
212545
GROUP PTAN
IL
05
—
34813100
—
WI
Enumeration date
05/17/2006
Last updated
02/03/2016
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