Provider Demographics
NPI:1952367468
Name:SONG, MIA M (MD)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:M
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:30 NORTH MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3802
Mailing Address - Country:US
Mailing Address - Phone:312-726-3917
Mailing Address - Fax:312-726-0474
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 607
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-726-3917
Practice Address - Fax:312-726-0474
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-104848207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH48079Medicare UPIN
IL952530Medicare ID - Type Unspecified