Healthcare Provider Details

I. General information

NPI: 1225011307
Provider Name (Legal Business Name): MIA M. GALIOTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/03/2020
Certification Date: 05/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W IRVING PARK RD APT 5116
CHICAGO IL
60613-3118
US

IV. Provider business mailing address

655 W IRVING PARK RD APT 5116
CHICAGO IL
60613-3118
US

V. Phone/Fax

Practice location:
  • Phone: 573-259-4730
  • Fax: 573-259-4730
Mailing address:
  • Phone: 573-259-4730
  • Fax: 573-259-4730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number23214
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number57168
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36076328
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: