Provider Demographics
NPI:1487855219
Name:MICHAEL MCNETT MD SC
Entity Type:Organization
Organization Name:MICHAEL MCNETT MD SC
Other - Org Name:THE FIBROMYALGIA TREATMENT CENTERS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-604-5321
Mailing Address - Street 1:4332 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2144
Mailing Address - Country:US
Mailing Address - Phone:773-604-5321
Mailing Address - Fax:773-604-5231
Practice Address - Street 1:4332 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2144
Practice Address - Country:US
Practice Address - Phone:773-604-5321
Practice Address - Fax:773-604-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF83119Medicare UPIN
IL208362Medicare ID - Type Unspecified
IL608160Medicare ID - Type Unspecified