| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 18 Lake St, Oak Park, Illinois |
| Authorized Official Name and Position | William Pedro Mcmiller (OWNER) |
| Authorized Official Contact | 7084340336 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 706 Oak Park IL 60303-0706 Ph: (708) 434-0336 | 18 Lake St Oak Park IL 60302-2606 Ph: (708) 434-0336 |
| NPI Number | 1487103453 |
|---|---|
| Provider Enumeration Date | 09/30/2016 |
| Last Update Date | 09/30/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487103453 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 036-078553 (Illinois) | Primary |
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