Provider Demographics
NPI:1376358895
Name:UPWARD HEALTH OF ILLINOIS PC
Entity type:Organization
Organization Name:UPWARD HEALTH OF ILLINOIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-540-8225
Mailing Address - Street 1:80 ARKAY DR STE 230
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3705
Mailing Address - Country:US
Mailing Address - Phone:833-342-1454
Mailing Address - Fax:
Practice Address - Street 1:208 S LA SALLE ST STE 814
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-1101
Practice Address - Country:US
Practice Address - Phone:833-342-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty