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NPI Code Detail

MEDICARE: MILES CALLAHAN

MEDICARE: MILES CALLAHAN
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
1225X00000XOccupational Therapist056.015652IL

General Provider Information

NPI Number : 1699268284
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILES CALLAHAN
Provider Business Mailing Address
First Line : 4935 W CARMEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2423
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3707 N KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-4503
Country : US
Telephone Number : 773-377-5492
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2018
Last Update Date : 09/12/2023

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Directions to “ MILES CALLAHAN ” Practice Location

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