Provider Demographics
NPI:1396831269
Name:HYTROS, MICHAL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:S
Last Name:HYTROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 233
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-631-0704
Mailing Address - Fax:773-631-0749
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 233
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-0704
Practice Address - Fax:773-631-0749
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083232Medicaid
F32761Medicare UPIN
IL982570Medicare ID - Type Unspecified