Provider Demographics
NPI:1639193329
Name:CLEARY, MIKE
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:CLEARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 BAKEWELL LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1637
Mailing Address - Country:US
Mailing Address - Phone:630-399-6137
Mailing Address - Fax:630-548-2357
Practice Address - Street 1:811 BAKEWELL LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1637
Practice Address - Country:US
Practice Address - Phone:630-399-6137
Practice Address - Fax:630-548-2357
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20214471313001Medicaid