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General NPI Number Information
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NPI Number | 1033222542
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Entity Type | Individual
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Provider Name | MICHELLE THERESA WATTERS MD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 2121 W TAYLOR ST SPH/EOHS, OCC. MED., MC 684
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City | CHICAGO
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State | IL
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Zip | 60612-4224
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Country | US
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Telephone | 312-413-0369
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 W TAYLOR ST SPH/EOHS, OCC. MED., MC 684
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City | CHICAGO
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State | IL
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Zip | 60612-4224
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Country | US
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Telephone | 312-413-0369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 036-107132
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License Number State | IL
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