Healthcare Provider Details

I. General information

NPI: 1063540458
Provider Name (Legal Business Name): AMELIA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E 65TH ST AT LAKE MICHIGAN
CHICAGO IL
60649-1395
US

IV. Provider business mailing address

733 S CUYLER AVE
OAK PARK IL
60304-1505
US

V. Phone/Fax

Practice location:
  • Phone: 773-256-5782
  • Fax:
Mailing address:
  • Phone: 708-386-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: