Provider Demographics
NPI:1629371984
Name:PAYANT, MISHA JOSEF (LAC, DAC)
Entity Type:Individual
Prefix:DR
First Name:MISHA
Middle Name:JOSEF
Last Name:PAYANT
Suffix:
Gender:M
Credentials:LAC, DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W PATTERSON AVE
Mailing Address - Street 2:1-E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4470
Mailing Address - Country:US
Mailing Address - Phone:773-746-9933
Mailing Address - Fax:
Practice Address - Street 1:356 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3416
Practice Address - Country:US
Practice Address - Phone:773-746-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000961171100000X
RIDA00369171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist