Healthcare Provider Details

I. General information

NPI: 1205754819
Provider Name (Legal Business Name): MIA NICOLE CHIDICHIMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W HIGGINS RD STE 370
HOFFMAN ESTATES IL
60169-7207
US

IV. Provider business mailing address

700 E ALGONQUIN RD UNIT 2307
SCHAUMBURG IL
60173-3835
US

V. Phone/Fax

Practice location:
  • Phone: 847-895-2910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: