Provider Demographics
NPI:1629244223
Name:MICHAEL C MOLAY DPM
Entity Type:Organization
Organization Name:MICHAEL C MOLAY DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-763-6655
Mailing Address - Street 1:5485 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1249
Mailing Address - Country:US
Mailing Address - Phone:773-763-6655
Mailing Address - Fax:773-763-5117
Practice Address - Street 1:5485 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1249
Practice Address - Country:US
Practice Address - Phone:773-763-6655
Practice Address - Fax:773-763-5117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002552332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4889040001Medicare NSC
IL520330Medicare PIN
ILT36881Medicare UPIN