Healthcare Provider Details

I. General information

NPI: 1114071735
Provider Name (Legal Business Name): MICHELLE ELISABETH KORZEC CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 W 19TH ST
CHICAGO IL
60623-3501
US

IV. Provider business mailing address

1250 S MICHIGAN AVE APT 805
CHICAGO IL
60605-3268
US

V. Phone/Fax

Practice location:
  • Phone: 773-484-4366
  • Fax: 773-521-1776
Mailing address:
  • Phone: 312-339-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209004242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: