MEDICARE: DR. GERALD MICHAEL HILLER PSY.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	103TC0700X	Clinical Psychologist		IL

General Provider Information

NPI Number	:	1417075870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD MICHAEL HILLER PSY.D

Provider Business Mailing Address
First Line	:	555 WEST MADISON STREET
Second Line	:	SUITE 1204
City	:	CHICAGO
State	:	IL
Zip	:	60661
Country	:	US
Telephone Number	:	312-902-3553
Fax Number	:	312-902-3556

Provider Business Practice Location Address
First Line	:	555 W MADISON ST
Second Line	:	SUITE 1204
City	:	CHICAGO
State	:	IL
Zip	:	60661-2514
Country	:	US
Telephone Number	:	312-902-3553
Fax Number	:	312-902-3556

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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