Provider Demographics
NPI:1730460106
Name:GATES, MICHAEL L
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:GATES
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 1:13 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2930
Mailing Address - Country:US
Mailing Address - Phone:630-540-5213
Mailing Address - Fax:630-540-9818
Practice Address - Street 1:13 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2930
Practice Address - Country:US
Practice Address - Phone:630-540-5213
Practice Address - Fax:630-540-9818
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist