Provider Demographics
NPI:1023184181
Name:HIGGINS, MICHAEL S
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S MARSHFIELD AVE
Mailing Address - Street 2:9TH FLOOR MC 732
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4305
Mailing Address - Country:US
Mailing Address - Phone:312-996-7699
Mailing Address - Fax:312-996-1001
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190165981223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T86698Medicare UPIN