Provider Demographics
NPI:1598911372
Name:MICHEHL, JAMES GERALD (MED)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GERALD
Last Name:MICHEHL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:SUITE 28
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1542
Mailing Address - Country:US
Mailing Address - Phone:847-347-4357
Mailing Address - Fax:866-931-5820
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:SUITE 28
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1542
Practice Address - Country:US
Practice Address - Phone:847-347-4357
Practice Address - Fax:866-931-5820
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008199101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health