Healthcare Provider Details

I. General information

NPI: 1407668379
Provider Name (Legal Business Name): MILES OF CARE SOUTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
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

P.O. BOX 437432
CHICAGO ILLINOIS
60643
UM

V. Phone/Fax

Practice location:
  • Phone: 844-438-2525
  • Fax: 708-933-3459
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TAMMISHIA LITTLE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 844-438-2525