Provider Demographics
NPI:1942276167
Name:OSWALD, MICHELE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:OSWALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3021
Mailing Address - Country:US
Mailing Address - Phone:708-895-2011
Mailing Address - Fax:
Practice Address - Street 1:3157 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3021
Practice Address - Country:US
Practice Address - Phone:708-895-2011
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000778207Q00000X
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609907OtherBC/BS OF ILLINOIS
IL21609907OtherBC/BS OF ILLINOIS
IL672780Medicare ID - Type Unspecified
IN187910Medicare ID - Type Unspecified