Healthcare Provider Details

I. General information

NPI: 1619123114
Provider Name (Legal Business Name): MARGARET GROSS MICHELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRAL ST SUITE 800
EVANSTON IL
60201-1777
US

IV. Provider business mailing address

1000 CENTRAL ST SUITE 800
EVANSTON IL
60201-1777
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2577
  • Fax: 847-733-5424
Mailing address:
  • Phone: 847-570-2577
  • Fax: 847-733-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125054703
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number125054703
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number036131101
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: