Provider Demographics
NPI:1396850855
Name:MICHAELS, ELI KASIMIR (MD)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:KASIMIR
Last Name:MICHAELS
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 1:1660 FEEHANVILLE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6036
Mailing Address - Country:US
Mailing Address - Phone:847-823-3185
Mailing Address - Fax:847-823-3318
Practice Address - Street 1:136 BIESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3657
Practice Address - Country:US
Practice Address - Phone:847-823-3185
Practice Address - Fax:847-823-3318
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044500208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044500Medicaid
IL036044500Medicaid
F400208391Medicare PIN
C43156Medicare UPIN