Healthcare Provider Details

I. General information

NPI: 1598871923
Provider Name (Legal Business Name): MICHAEL REILLY M.D. HOLISTIC & FAMILY PRACTICE MEDICINE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NORTHWEST HWY SUITE 104
FOX RIVER GROVE IL
60021-1925
US

IV. Provider business mailing address

912 NORTHWEST HWY SUITE 104
FOX RIVER GROVE IL
60021-1925
US

V. Phone/Fax

Practice location:
  • Phone: 847-516-4400
  • Fax: 847-516-4404
Mailing address:
  • Phone: 847-516-4400
  • Fax: 847-516-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036100776
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL F REILLY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-516-4400