Provider Demographics
NPI:1083909998
Name:ANDREOLI, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:ANDREOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:636 RAYMOND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9792
Mailing Address - Country:US
Mailing Address - Phone:331-732-4370
Mailing Address - Fax:331-732-4375
Practice Address - Street 1:636 RAYMOND DR STE 300
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9792
Practice Address - Country:US
Practice Address - Phone:331-732-4370
Practice Address - Fax:331-732-4375
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036137966207W00000X, 207W00000X
MA248343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine