Individual
MR. AUGUSTO MIRAVALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1725 W HARRISON ST STE 309, CHICAGO, IL 60612-3844
(312) 942-8011
(970) 226-6707
Mailing address
1725 W HARRISON ST STE 309, CHICAGO, IL 60612-3844
(312) 942-8011
(970) 226-6707
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
0047246
CO
2084N0400X
Neurology Physician
Primary
036118267
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020217800
—
FL
Enumeration date
01/29/2009
Last updated
07/28/2023
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