Healthcare Provider Details

I. General information

NPI: 1285384602
Provider Name (Legal Business Name): MICHELLE JAMILYN KUHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SOUTH WOOD STREET SUITE 100, MC 675
CHICAGO IL
60612
US

IV. Provider business mailing address

820 SOUTH WOOD STREET SUITE 100, MC 675
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2933
  • Fax:
Mailing address:
  • Phone: 312-996-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1285384602
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: