Healthcare Provider Details

I. General information

NPI: 1699224998
Provider Name (Legal Business Name): MICHAEL ESPOSITO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 S SHORE DR
CHICAGO IL
60637-5051
US

IV. Provider business mailing address

5326 S CORNELL AVE 501
CHICAGO IL
60615-7100
US

V. Phone/Fax

Practice location:
  • Phone: 815-382-8966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160007609
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: