Healthcare Provider Details

I. General information

NPI: 1902212327
Provider Name (Legal Business Name): ANDREW JOSEPH MICHALOWITZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W. 127TH ST GARDEN LEVEL
PLAINFIELD IL
60585-9507
US

IV. Provider business mailing address

1000 HARRINGTON ST
MOUNT CLEMENS MI
48043-2920
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-7000
  • Fax: 815-230-6255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101021271
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036153465
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: