Provider Demographics
NPI:1508167511
Name:MILLWALA, ADILA (PT CWS)
Entity Type:Individual
Prefix:
First Name:ADILA
Middle Name:
Last Name:MILLWALA
Suffix:
Gender:F
Credentials:PT CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4677 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5834
Mailing Address - Country:US
Mailing Address - Phone:312-404-2234
Mailing Address - Fax:
Practice Address - Street 1:4677 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5834
Practice Address - Country:US
Practice Address - Phone:312-404-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-07
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009785171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor