Provider Demographics
NPI:1568431377
Name:DRALLE, MICHAEL DEAN (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEAN
Last Name:DRALLE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 WENNES CT
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2727
Mailing Address - Country:US
Mailing Address - Phone:630-654-3485
Mailing Address - Fax:
Practice Address - Street 1:8937 GRAND AVE
Practice Address - Street 2:ATHLETICO SPORTS MEDICINE AND PT CENTERS
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171
Practice Address - Country:US
Practice Address - Phone:708-453-1354
Practice Address - Fax:708-453-2679
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer