MEDICARE: MIA M. GALIOTO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	23214	AZ
2	2084P0804X	Child & Adolescent Psychiatry Physician	57168	GA
3	2084P0800X	Psychiatry Physician	36076328	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225011307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA M. GALIOTO M.D.

Provider Business Mailing Address
First Line	:	655 W IRVING PARK RD APT 5116
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3118
Country	:	US
Telephone Number	:	573-259-4730
Fax Number	:	573-259-4730

Provider Business Practice Location Address
First Line	:	655 W IRVING PARK RD APT 5116
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3118
Country	:	US
Telephone Number	:	573-259-4730
Fax Number	:	573-259-4730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	05/03/2020

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