Provider Demographics
NPI:1184853558
Name:PINE, MICHAEL BOEHMER (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BOEHMER
Last Name:PINE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1210 CHICAGO AVE
Mailing Address - Street 2:STE 503
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-6515
Mailing Address - Country:US
Mailing Address - Phone:847-492-0162
Mailing Address - Fax:847-492-8130
Practice Address - Street 1:1210 CHICAGO AVE
Practice Address - Street 2:STE 503
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-6515
Practice Address - Country:US
Practice Address - Phone:847-492-0162
Practice Address - Fax:847-492-8130
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
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Provider Licenses
StateLicense IDTaxonomies
IL036075448207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease