Individual
DR. KEITH ALAN MIHALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
400 W DUNDEE RD, SUITE 14-15, BUFFALO GROVE, IL 60089-3415
(847) 459-9119
(847) 459-8115
Mailing address
400 W DUNDEE RD, SUITE 14-15, BUFFALO GROVE, IL 60089-3415
(847) 459-9119
(847) 459-8115
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007845
IL
152W00000X
Optometrist
18002176A
IL
152W00000X
Optometrist
OPC002198
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0410048631
MEDICARE ID
IL
01
—
1605476
BLUE CROSS BLUE SHIELD IL
IL
01
—
363614738
TAX ID
IL
01
—
5303296
AETNA
IL
Enumeration date
04/06/2006
Last updated
07/02/2008
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