Provider Demographics
NPI:1144754839
Name:MIRONOVA, GALINA E (ND)
Entity Type:Individual
Prefix:DR
First Name:GALINA
Middle Name:E
Last Name:MIRONOVA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:GALINA
Other - Middle Name:E
Other - Last Name:MAHLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:2922 W TOUHY AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2938
Mailing Address - Country:US
Mailing Address - Phone:224-470-9474
Mailing Address - Fax:
Practice Address - Street 1:2922 W TOUHY AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2938
Practice Address - Country:US
Practice Address - Phone:224-300-4886
Practice Address - Fax:224-765-8456
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA886175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath