Provider Demographics
NPI:1487643003
Name:HORVATH, MICHELLE L (PAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:HORVATH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16151 WEBER RD SUITE 201
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403
Mailing Address - Country:US
Mailing Address - Phone:815-838-2888
Mailing Address - Fax:
Practice Address - Street 1:16151 WEBER RD SUITE 201
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-8139
Practice Address - Country:US
Practice Address - Phone:815-838-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P06707Medicare UPIN
IL583130Medicare ID - Type Unspecified