Healthcare Provider Details

I. General information

NPI: 1356769210
Provider Name (Legal Business Name): MICHAEL VERRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E. CHICAGO AVE BOX 152
CHICAGO IL
60611
US

IV. Provider business mailing address

225 E. CHICAGO AVE BOX 152
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.143068
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: