Healthcare Provider Details

I. General information

NPI: 1184961526
Provider Name (Legal Business Name): MICHELLE HARMON GOEBEL-ANGEL L.AC, MSOM, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MICHIGAN AVE SUITE 450
CHICAGO IL
60611-3777
US

IV. Provider business mailing address

500 N MICHIGAN AVE SUITE 450
CHICAGO IL
60611-3777
US

V. Phone/Fax

Practice location:
  • Phone: 312-276-1212
  • Fax:
Mailing address:
  • Phone: 312-276-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.000899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: