Healthcare Provider Details

I. General information

NPI: 1710919469
Provider Name (Legal Business Name): KAREN J MILCHUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN MISAMORE

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 E BELVIDERE RD
GRAYSLAKE IL
60030
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-0360
  • Fax: 847-548-0716
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056003390
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number2140 26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: