Provider Demographics
NPI:1063539005
Name:MILDER AND ASSOCIATES
Entity type:Organization
Organization Name:MILDER AND ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-665-6810
Mailing Address - Street 1:25W560 GENEVA RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2233
Mailing Address - Country:US
Mailing Address - Phone:630-665-6810
Mailing Address - Fax:630-665-7940
Practice Address - Street 1:700 S BARTLETT RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4607
Practice Address - Country:US
Practice Address - Phone:630-483-7601
Practice Address - Fax:630-483-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001683314OtherBLUE CROSS BLUE SHIELD
IL971840Medicare ID - Type UnspecifiedMEDICARE PRACTICE ID