Healthcare Provider Details

I. General information

NPI: 1639163173
Provider Name (Legal Business Name): JOSEPH N MICHELOTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S 8TH ST
WEST DUNDEE IL
60118-2248
US

IV. Provider business mailing address

351 SHARON DR
BARRINGTON IL
60010-3412
US

V. Phone/Fax

Practice location:
  • Phone: 847-776-1200
  • Fax: 847-776-9400
Mailing address:
  • Phone: 847-776-1200
  • Fax: 847-776-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number03655132
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: