Healthcare Provider Details

I. General information

NPI: 1477948131
Provider Name (Legal Business Name): MICHELE SACHIKO O'SHEA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E HURON ST MCGAW PAVILION STE 1-203
CHICAGO IL
60611-2909
US

IV. Provider business mailing address

17769 N 89TH LN
PEORIA AZ
85382-4007
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-7430
  • Fax:
Mailing address:
  • Phone: 623-266-1545
  • 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 Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number036160813
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: