Healthcare Provider Details

I. General information

NPI: 1093998874
Provider Name (Legal Business Name): MICHAEL ANDREW PAUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BARRINGTON RD DOB #1, SUITE 430
HOFFMAN ESTATES IL
60169-1019
US

IV. Provider business mailing address

1555 BARRINGTON RD DOB #1, SUITE 430
HOFFMAN ESTATES IL
60169-1019
US

V. Phone/Fax

Practice location:
  • Phone: 847-884-1212
  • Fax:
Mailing address:
  • Phone: 847-884-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-112557
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036-112557
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: