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General NPI Number Information
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NPI Number | 1376358895
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Entity Type | Organization
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Legal Business Name | UPWARD HEALTH OF ILLINOIS PC
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 208 S LA SALLE ST STE 814
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City | CHICAGO
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State | IL
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Zip | 60604-1101
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Country | US
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Telephone | 833-342-1454
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Fax |
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Provider Business Mailing Address
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Address Line | 80 ARKAY DR STE 230
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City | HAUPPAUGE
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State | NY
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Zip | 11788-3705
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Country | US
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Telephone | 833-342-1454
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENNIS MIHALE
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Credential | MD
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Telephone | 631-540-8225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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