Healthcare Provider Details

I. General information

NPI: 1063539005
Provider Name (Legal Business Name): MILDER AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S BARTLETT RD
BARTLETT IL
60103-4607
US

IV. Provider business mailing address

25W560 GENEVA RD SUITE 4
CAROL STREAM IL
60188-2233
US

V. Phone/Fax

Practice location:
  • Phone: 630-483-7601
  • Fax: 630-483-7801
Mailing address:
  • Phone: 630-665-6810
  • Fax: 630-665-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES C. MILDER
Title or Position: OWNER
Credential: P.T.
Phone: 630-665-6810