Healthcare Provider Details

I. General information

NPI: 1124079744
Provider Name (Legal Business Name): MIA L. NORLIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N KINGSBURY ST STE 130N
CHICAGO IL
60610-7457
US

IV. Provider business mailing address

30 N MICHIGAN AVE STE 300
CHICAGO IL
60602-4495
US

V. Phone/Fax

Practice location:
  • Phone: 312-775-1100
  • Fax: 312-775-1111
Mailing address:
  • Phone: 312-726-3917
  • Fax: 312-726-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036-104628
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036.104628
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: