Healthcare Provider Details

I. General information

NPI: 1841980992
Provider Name (Legal Business Name): MICHEALA LEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S LATHAM ST
SANDWICH IL
60548-2276
US

IV. Provider business mailing address

100 S LATHAM ST STE 202
SANDWICH IL
60548-1888
US

V. Phone/Fax

Practice location:
  • Phone: 815-786-2182
  • Fax:
Mailing address:
  • Phone: 815-786-2182
  • Fax: 815-786-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019037291
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: