Provider Demographics
NPI:1134144645
Name:MILNAMOW, NICOLE DUREK (PT DPT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DUREK
Last Name:MILNAMOW
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:DUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6105 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2313
Practice Address - Country:US
Practice Address - Phone:773-279-0927
Practice Address - Fax:773-279-0951
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202845032Medicare PIN
IL216859105Medicare PIN
K07671Medicare UPIN
IL374610Medicare ID - Type Unspecified