Basic Information
| Provider Information | |||||||||
| NPI: | 1164809497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIHELICH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 SHUMAN BLVD | ||||||||
| Address2: | STE 401 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605638458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303035380 | ||||||||
| FaxNumber: | 9783136824 | ||||||||
| Practice Location | |||||||||
| Address1: | 1512 ARTAIUS PKWY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475730073 | ||||||||
| FaxNumber: | 8475738660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2015 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 3160 | IL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.