Provider Demographics
NPI:1518300375
Name:MICHAEL, DAVID RALPH (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RALPH
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2337 W WOLFRAM ST APT 415
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-8051
Mailing Address - Country:US
Mailing Address - Phone:312-535-9614
Mailing Address - Fax:312-586-8301
Practice Address - Street 1:2334 W LAWRENCE AVE STE 221
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1030
Practice Address - Country:US
Practice Address - Phone:312-535-9614
Practice Address - Fax:312-535-8301
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63306-212084P0800X
IL0361443552084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program