Healthcare Provider Details

I. General information

NPI: 1578246831
Provider Name (Legal Business Name): MICHELLE GELMAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORAN MICHELLE GELMAN NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 SKOKIE BLVD
SKOKIE IL
60077-2545
US

IV. Provider business mailing address

750 PLEASANT AVE
HIGHLAND PARK IL
60035-4613
US

V. Phone/Fax

Practice location:
  • Phone: 847-410-6501
  • Fax:
Mailing address:
  • Phone: 847-971-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.027376
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: