Provider Demographics
NPI:1659440097
Name:SLOGOFF, MICHELE I (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:I
Last Name:SLOGOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2542
Mailing Address - Country:US
Mailing Address - Phone:630-208-7874
Mailing Address - Fax:630-208-7880
Practice Address - Street 1:1665 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2542
Practice Address - Country:US
Practice Address - Phone:630-208-7874
Practice Address - Fax:630-208-7880
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111435208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111435Medicaid
IL723850Medicare PIN