Individual
ALEXA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 S MAJOR ST, EUREKA, IL 61530-1246
(309) 467-4691
(309) 467-6229
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036151215
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125.071480
LICENSE
—
Enumeration date
06/29/2017
Last updated
08/10/2020
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