MEDICARE: JOSEPH N MICHELOTTI MD

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	208600000X	Surgery Physician	03655132	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639163173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH N MICHELOTTI MD

Provider Business Mailing Address
First Line	:	351 SHARON DR
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-3412
Country	:	US
Telephone Number	:	847-776-1200
Fax Number	:	847-776-9400

Provider Business Practice Location Address
First Line	:	350 S 8TH ST
Second Line	:
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-2248
Country	:	US
Telephone Number	:	847-776-1200
Fax Number	:	847-776-9400

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	05/16/2011

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