Healthcare Provider Details

I. General information

NPI: 1174591531
Provider Name (Legal Business Name): MICHAEL SEVERINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD STE 500
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD STE 500
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-232-2800
  • Fax: 630-232-3895
Mailing address:
  • Phone: 630-232-2800
  • Fax: 630-232-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036082780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: