Healthcare Provider Details

I. General information

NPI: 1689888224
Provider Name (Legal Business Name): MICHELLE CATENACCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TOWER CT SUITE F
GURNEE IL
60031-3322
US

IV. Provider business mailing address

30 TOWER COURT SUITE F
GURNEE IL
60031-3322
US

V. Phone/Fax

Practice location:
  • Phone: 847-662-1818
  • Fax: 847-662-3001
Mailing address:
  • Phone: 847-662-1818
  • Fax: 847-662-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number036129603
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35093807
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: