Healthcare Provider Details

I. General information

NPI: 1124464912
Provider Name (Legal Business Name): SURESTEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 BRIARGATE DR
SOUTH ELGIN IL
60177-2225
US

IV. Provider business mailing address

471 BRIARGATE DR
SOUTH ELGIN IL
60177-2225
US

V. Phone/Fax

Practice location:
  • Phone: 224-535-8624
  • Fax: 847-429-2078
Mailing address:
  • Phone: 224-535-8624
  • Fax: 847-429-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number036.131190
License Number StateIL

VIII. Authorized Official

Name: AARON MILLER
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 224-535-8624