Healthcare Provider Details

I. General information

NPI: 1942276167
Provider Name (Legal Business Name): MICHELE OSWALD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 RIDGE RD
LANSING IL
60438-3021
US

IV. Provider business mailing address

3157 RIDGE RD
LANSING IL
60438-3021
US

V. Phone/Fax

Practice location:
  • Phone: 708-895-2011
  • Fax:
Mailing address:
  • Phone: 708-895-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02000778
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: