Healthcare Provider Details

I. General information

NPI: 1639969405
Provider Name (Legal Business Name): MILES OF CARE INFUSION & WELLNESS DIVISON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10408 S WESTERN AVE STE A
CHICAGO IL
60643-2508
US

IV. Provider business mailing address

PO BOX 19111
CHICAGO IL
60619-0002
US

V. Phone/Fax

Practice location:
  • Phone: 773-960-1202
  • Fax: 708-933-3459
Mailing address:
  • Phone: 773-960-1202
  • Fax: 708-933-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMISHIA LITTLE
Title or Position: AUTHORIZED REP
Credential: NURSE
Phone: 773-960-1202