MEDICARE: DR. MICAELA DELLA TORRE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	036112792	IL
2	207VM0101X	Maternal & Fetal Medicine Physician	01071567A	IN
3	207VM0101X	Maternal & Fetal Medicine Physician	036112792	IL

General Provider Information

NPI Number	:	1598798779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICAELA DELLA TORRE M.D.

Provider Business Mailing Address
First Line	:	200 W ADAMS ST
Second Line	:	SUITE 225
City	:	CHICAGO
State	:	IL
Zip	:	60606-3242
Country	:	US
Telephone Number	:	312-704-2885
Fax Number	:	312-704-2737

Provider Business Practice Location Address
First Line	:	100 NAVARRE PL STE 4410
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-1171
Country	:	US
Telephone Number	:	574-647-1650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/02/2025

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