Healthcare Provider Details

I. General information

NPI: 1326622341
Provider Name (Legal Business Name): MICHAEL JAMES TAGGE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 N HARLEM AVE
CHICAGO IL
60707-2718
US

IV. Provider business mailing address

1450 PORTSMOUTH CT
NORTHBROOK IL
60062-4622
US

V. Phone/Fax

Practice location:
  • Phone: 224-328-6466
  • Fax: 224-326-0567
Mailing address:
  • Phone: 312-402-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number016.005984
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: