Healthcare Provider Details

I. General information

NPI: 1306194089
Provider Name (Legal Business Name): NINA D UZIEL-MILLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N MICHIGAN AVE SUITE 1715
CHICAGO IL
60611-3110
US

IV. Provider business mailing address

625 N MICHIGAN AVE SUITE 1715
CHICAGO IL
60611-3110
US

V. Phone/Fax

Practice location:
  • Phone: 312-440-9396
  • Fax:
Mailing address:
  • Phone: 312-440-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.006375
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: