Provider Demographics
NPI:1598871923
Name:MICHAEL REILLY M.D. HOLISTIC & FAMILY PRACTICE MEDICINE LTD
Entity Type:Organization
Organization Name:MICHAEL REILLY M.D. HOLISTIC & FAMILY PRACTICE MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-516-4400
Mailing Address - Street 1:912 NORTHWEST HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1925
Mailing Address - Country:US
Mailing Address - Phone:847-516-4400
Mailing Address - Fax:847-516-4404
Practice Address - Street 1:912 NORTHWEST HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1925
Practice Address - Country:US
Practice Address - Phone:847-516-4400
Practice Address - Fax:847-516-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932191OtherBLUE SHIELD BLUE CROSS
IL036100776Medicaid
IL036100776Medicaid
ILH14202Medicare UPIN