Healthcare Provider Details

I. General information

NPI: 1629857917
Provider Name (Legal Business Name): MICHELLE N CRUITT HID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MAXSON HID

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OAKBROOK CENTER SUITE 709
OAK BROOK IL
60523
US

IV. Provider business mailing address

142 E ONTARIO ST SUITE 1100
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-263-7171
  • Fax: 312-263-5410
Mailing address:
  • Phone: 312-263-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3560
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: