Healthcare Provider Details

I. General information

NPI: 1841617396
Provider Name (Legal Business Name): MICHAEL SPEWAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2014
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E HURON ST SUITE 1-200
CHICAGO IL
60611-2909
US

IV. Provider business mailing address

225 E CHICAGO AVE # 152
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-7975
  • Fax:
Mailing address:
  • Phone: 312-227-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036143519
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: