Healthcare Provider Details

I. General information

NPI: 1164331633
Provider Name (Legal Business Name): MIA KURTZHALTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 WAUKEGAN RD
GLENVIEW IL
60025-3022
US

IV. Provider business mailing address

2228 PRAIRIE ST
GLENVIEW IL
60025-2829
US

V. Phone/Fax

Practice location:
  • Phone: 847-486-4140
  • Fax:
Mailing address:
  • Phone: 224-456-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: