Provider Demographics
NPI:1629183223
Name:FLOOD, MICHEAL T (DPM)
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:T
Last Name:FLOOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:STE 1914
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1903
Mailing Address - Country:US
Mailing Address - Phone:312-641-2999
Mailing Address - Fax:312-641-6534
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:STE 1914
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1903
Practice Address - Country:US
Practice Address - Phone:312-641-2999
Practice Address - Fax:312-641-6534
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU51924Medicare UPIN
IL354980Medicare PIN
IL4307560001Medicare NSC