Healthcare Provider Details

I. General information

NPI: 1447203526
Provider Name (Legal Business Name): MICHAEL R. HALPERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N. ST CLAIR STREET SUITE 1880
CHICAGO IL
60611-3197
US

IV. Provider business mailing address

676 N. ST CLAIR STREET SUITE 1880
CHICAGO IL
60611-3197
US

V. Phone/Fax

Practice location:
  • Phone: 312-642-9844
  • Fax: 312-642-7637
Mailing address:
  • Phone: 312-642-9844
  • Fax: 312-642-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036-043395
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: