Healthcare Provider Details

I. General information

NPI: 1639087281
Provider Name (Legal Business Name): MICHAEL FLANNERY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 JOHNSON DR APT 2536
BUFFALO GROVE IL
60089-6517
US

IV. Provider business mailing address

1221 JOHNSON DR APT 2536
BUFFALO GROVE IL
60089-6517
US

V. Phone/Fax

Practice location:
  • Phone: 847-858-0903
  • Fax:
Mailing address:
  • Phone: 847-858-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: