Healthcare Provider Details

I. General information

NPI: 1952391955
Provider Name (Legal Business Name): MIKHAIL WOLF GEYER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 02/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 W HINTZ RD SUITE 1
WHEELING IL
60090-5281
US

IV. Provider business mailing address

6202 S HALSTED ST SUITE 1
CHICAGO IL
60621-2029
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-7482
  • Fax: 847-258-7494
Mailing address:
  • Phone: 847-259-7482
  • Fax: 847-258-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019-023529
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: