Provider Demographics
NPI:1417075870
Name:HILLER, GERALD MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MICHAEL
Last Name:HILLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 WEST MADISON STREET
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661
Mailing Address - Country:US
Mailing Address - Phone:312-902-3553
Mailing Address - Fax:312-902-3556
Practice Address - Street 1:555 W MADISON ST
Practice Address - Street 2:SUITE 1204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2514
Practice Address - Country:US
Practice Address - Phone:312-902-3553
Practice Address - Fax:312-902-3556
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical