Healthcare Provider Details

I. General information

NPI: 1982957916
Provider Name (Legal Business Name): VICTORIA L CHILO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 N STATE ROUTE 50
BOURBONNAIS IL
60914-9304
US

IV. Provider business mailing address

597 N YORK ST
ELMHURST IL
60126-1903
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-0919
  • Fax:
Mailing address:
  • Phone: 630-833-8382
  • Fax: 630-833-8158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3013
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: