Provider Demographics
NPI:1477715142
Name:MICHEL MEDICAL ASSOC., S.C.
Entity Type:Organization
Organization Name:MICHEL MEDICAL ASSOC., S.C.
Other - Org Name:MICHEL MEDICAL ASSOC., S.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:ROC
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-842-4468
Mailing Address - Street 1:2600 S MICHIGAN AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2860
Mailing Address - Country:US
Mailing Address - Phone:312-842-4468
Mailing Address - Fax:312-842-2318
Practice Address - Street 1:2600 S MICHIGAN AVE STE 314
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2860
Practice Address - Country:US
Practice Address - Phone:312-842-4468
Practice Address - Fax:312-842-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-000140207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL604330Medicare UPIN