Healthcare Provider Details

I. General information

NPI: 1851354484
Provider Name (Legal Business Name): MICHELLE E. AQUINO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE E. AQUINO-CABALLERO D.O.

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

2650 RIDGE AVE # 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036178776
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS8554
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036178776
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: